Dr.Anwesha Manna, M17851
Bilateral fourth nerve palsy after ventriculo-peritoneal shunt is a very rare occurrence.
A 9 years old female presented with occasional diplopia since last 1 week. She was undergone V-P shunt 15 days before for obstructive hydrocephalus following tubercular meningitis. She is on ATD. On examination UCVA BE was 20/20. She had a chin depression head posture. She was orthotropic in primary gaze. On right gaze & left head tilt there was left hypertropia 8 PD & on left gaze & right tilt there was right hypertropia 6 PD. On down gaze she had 10 PD esotropia. Fundus photo was suggestive of excyclotorsion in BE . In double Maddox rod testing 15 degree torsion was there.. CT scan & MRI showed no abnormality except V-P shunt deep in lateral ventricle.
We are regularly following the patient as the diplopia is occasional. We shall plan for surgical correction depending on amount of hypertropia. She is on anti tubercular medicine for memingitis
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