Fourth nerve palsy in pseudotumor cerebri

A 13-year-old white female with a past medical history of facial acne treated with minocycline presented with headaches, normal visual acuity, bilaterally enlarged blind spots on visual field testing due to bilateral disc edema, and a right fourth nerve palsy. Neuroimaging studies were normal and a lumbar puncture revealed an elevated opening pressure but normal cerebrospinal fluid contents. The diagnosis of pseudotumor cerebri was made and the patient was treated with acetazolamide. The papilledema improved over several weeks and the fourth nerve palsy resolved completely. Fourth nerve palsy is an uncommonly reported nonlocalizing sign in pseudotumor cerebri.