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Learning from errors
Lower cranial nerve palsy, aseptic meningitis and hydrocephalus: unusual presentation of primary antiphospholipid syndrome
  1. Abdul Majid Wani1,
  2. Waleed Mohd Hussain1,
  3. Mohamad Ibrahim Fatani1,
  4. Ahmad Qadmani1,
  5. Ghassan Adnan Al Maimani2,
  6. Ahmad Turkistani2,
  7. Khalid S Dairi2,
  8. Ahmad Abumatar1,
  9. Mazen G Bafaraj1
  1. 1
    Hera General Hospital, Medicine, 4a/201, Makkah, Western, 21955, Saudi Arabia
  2. 2
    Omul Qurah University, Makkah, 21955, Saudi Arabia
  1. Abdul Majid Wani, dr_wani_majid{at}


Presentation of primary antiphospholipid syndrome (APS) is usually untrustworthy and unusual presentations are difficult to diagnose on the basis of clinical features alone. This is true especially in young and elderly patients. Cerebral venous thrombosis (CVT) is less frequent than arterial thrombosis in APS. CVT has a wide spectrum of signs and symptoms, which may evolve suddenly or over weeks. It mimics many neurological conditions such as meningitis, encephalopathy, benign intracranial hypertension and stroke. Headache is the most frequent symptom in patients with CVT, and is present in about 80% of cases. The most common pattern of presentation is with a benign intracranial hypertension-like syndrome. Sixth cranial nerve palsy usually manifests as a false localising sign. Patients may have recurrent seizures. Cranial nerve syndromes are seen with venous sinus thrombosis. We present a case of APS with lower cranial nerve palsy, aseptic meningitis and hydrocephalus initially treated as tuberculous meningitis.

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  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.