Isolated Abducens Palsy- Sole Manifestation of Acephalgic Spontaneous Intracranial Hypotension

Orthostatic headache symptoms are usually seen in patients with spontaneous intracranial hypotension (SIH), usually after medical procedures like lumbar puncture. We report a case of a 55 year old lady who presented with diplopia and right lateral rectus palsy with no headache. A diagnosis of SIH was made on MRI showing bilateral subdural effusions with chinked ventricles and distended venous sinuses. Patient improved with conservative measures. Although SIH is considered as a benign and self-limited condition, it can be associated with disabling complications like an abducens palsy. Hence it is important to be aware of this condition as SIH is an increasingly common diagnosis in clinical practice.