Unilateral Abducens Nerve Palsy After Intracranial Pressure Normalization in Postpartum Cerebral Venous Sinus Thrombosis

Unilateral Abducens Nerve Palsy After Intracranial Pressure Normalization in Postpartum Cerebral Venous Sinus Thrombosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Unilateral Abducens Nerve Palsy After Intracranial Pressure Normalization in Postpartum Cerebral Venous Sinus Thrombosis Mert Demirel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9499948/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Cerebral venous sinus thrombosis (CVST) disproportionately affects women, with a reported incidence of approximately 7 per 100,000 deliveries in the peripartum period. Abducens nerve palsy in CVST is classically attributed to raised intracranial pressure (ICP) and typically presents as a bilateral false localizing sign. Isolated unilateral involvement emerging after ICP normalization is rarely reported. Case presentation: A previously healthy 22-year-old gravida 4, para 4 woman presented on postpartum day 11 with severe headache and left-sided paresthesia. MRI demonstrated diffusion restriction in the left frontal region, and magnetic resonance venography revealed extensive superior sagittal sinus thrombosis. Opening lumbar puncture pressure was 360 mmH₂O. She was started on therapeutic anticoagulation and acetazolamide. On postpartum day 17, despite documented ICP normalization to 210 mmH₂O and partial radiological recanalization, she developed new-onset left abducens nerve palsy with horizontal binocular diplopia. Examination confirmed isolated left lateral rectus weakness without papilledema or additional cranial nerve deficits. With continued anticoagulation, the palsy gradually resolved over eight weeks. Discussion : The emergence of unilateral abducens palsy after ICP normalization and during radiological recanalization argues against ongoing pressure-mediated traction as the sole mechanism. Alternative explanations include focal ischemic injury to the nerve, localized inflammation at Dorello's canal, or delayed reperfusion-related microvascular dysfunction. Conclusion : New focal neurological deficits emerging during the recovery phase of postpartum CVST warrant immediate reassessment, including repeat neuroimaging and ophthalmologic evaluation, even when ICP has normalized and radiological recanalization is underway. Neurology cerebral venous sinus thrombosis abducens nerve palsy postpartum superior sagittal sinus intracranial pressure Figures Figure 1 Full Text Cerebral venous sinus thrombosis (CVST) accounts for approximately 0.5–1% of strokes in adults and disproportionately affects women, with a reported incidence of roughly 7 per 100,000 deliveries in the postpartum period [1, 2]. Cranial nerve involvement is uncommon; when it occurs, the abducens nerve is most frequently affected because of its long intracranial course and vulnerability to raised intracranial pressure (ICP) [3]. Reported abducens palsies in CVST are typically bilateral and co-occur with elevated ICP. Unilateral abducens palsy emerging during the treatment course—particularly after ICP has normalized—is rarely reported and mechanistically poorly understood. To the best of our knowledge, no previous case of unilateral abducens palsy in postpartum CVST has been described. A previously healthy 22-year-old gravida 4, para 4 woman presented on postpartum day 11 with severe headache and left-sided paresthesia. Initial MRI demonstrated diffusion restriction in the left frontal region and superior sagittal sinus thrombosis (Fig. 1a). Fundoscopy showed bilateral grade 1 papilledema. Subcutaneous enoxaparin and acetazolamide (250 mg three times daily) were initiated. A thrombophilia workup—factor V Leiden mutation, prothrombin G20210A mutation, antiphospholipid antibodies, and protein C/S—was unremarkable. Lumbar puncture on postpartum day 12 revealed an opening pressure of 360 mmH₂O with otherwise normal CSF constituents. The headache gradually resolved over the following days (Fig. 1b). On postpartum day 17, the patient reported visual impairment; neurological examination disclosed an isolated left abducens nerve palsy (Fig. 1c). A repeat lumbar puncture performed at symptom onset yielded an opening pressure of 210 mmH₂O, and therapeutic drainage was deferred given the normal pressure. To exclude thrombus progression or a new ischemic event, contrast-enhanced magnetic resonance venography (MRV) and diffusion imaging were repeated; these demonstrated no new diffusion restriction in the brainstem or elsewhere and showed partial recanalization of the superior sagittal sinus (Fig. 1d). The patient remained clinically stable with persistent left abducens palsy and no headache on postpartum day 20 and was discharged on enoxaparin. Written informed consent for publication was obtained from the patient. Several mechanisms have been proposed for abducens involvement in CVST. Raised ICP producing bilateral, pressure-dependent palsy is the most widely cited and fits classic “false localizing sign” pathophysiology; bilateral sixth-nerve palsy with papilledema two weeks after cesarean delivery has been reported in this setting [3]. Thrombosis of the inferior petrosal sinus or adjacent venous structures can compress the sixth nerve within Dorello’s canal, producing unilateral palsy by direct mass effect [5]; MRV in our patient did not show thrombosis of these structures. Isolated unilateral lateral rectus palsy has also been described in pregnancy-related CVST, although that report concerned antepartum thrombosis of unspecified venous structures rather than superior sagittal sinus thrombosis during active anticoagulation [4]. The clinical trajectory of our patient is distinctive in that abducens palsy emerged after ICP had normalized and during radiological recanalization. This timing argues against ongoing pressure-mediated nerve stretch or direct compressive thrombosis at the time of symptom onset, and instead suggests a delayed injury mechanism. Candidate explanations include venous congestion–related microvascular ischemia, with impaired oxygen and glucose delivery within the intrinsic vasa nervorum of the abducens nerve, and dynamic changes in transmural pressure as ICP falls while venous outflow is still being restored. A rapid reduction in ICP during treatment may transiently unmask vulnerable segments of the nerve that were previously stabilized by uniformly elevated surrounding pressures. This mechanism is speculative but is consistent with the anatomical course of the abducens nerve, its high metabolic sensitivity, and the delayed, unilateral pattern observed here. Several practical lessons emerge. Postpartum patients with acute focal neurological deficits warrant prompt evaluation for CVST, irrespective of atypical features. A new focal deficit appearing during treatment should not be reflexively attributed to thrombotic progression; here, the deficit emerged in the setting of imaging improvement and normalized CSF pressure. Finally, unilateral cranial neuropathy in CVST may reflect mechanisms independent of raised ICP, and recognition of this possibility can avoid unnecessary escalation of anticoagulation or cerebrospinal fluid diversion and guide more measured management. References Stam J (2005) Thrombosis of the cerebral veins and sinuses. N Engl J Med 352:1791–1798. https://doi.org/10.1056/NEJMra042354 Zhang X, Fang K, Zhang Y, Song J, Wang R, Ji X, Meng R, Zhou D (2025) Cerebral venous thrombosis during pregnancy and postpartum: a systematic review and meta-analysis. Int J Stroke 20:1188–1200. https://doi.org/10.1177/17474930251355751 Buljan K, Šarić G, Czersky Hafner D, Perković R (2019) Bilateral abducens nerve palsy due to extensive cerebral venous sinus thrombosis. Medicina (Kaunas) 55:115. https://doi.org/10.3390/medicina55040115 Nandini SA, Sahana R, Mitra R, Venkatesh BS (2023) Central dural venous thrombosis presenting with lateral rectus palsy in pregnancy. Int J Clin Obstet Gynaecol 7:450–452. https://doi.org/10.33545/gynae.2023.v7.i3d.1349 Mittal SO, Siddiqui J, Katirji B (2017) Abducens nerve palsy due to inferior petrosal sinus thrombosis. J Clin Neurosci 40:69–71. https://doi.org/10.1016/j.jocn.2017.02.018 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9499948","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":627970944,"identity":"9abd453e-7721-41ee-9830-da13f9b0f392","order_by":0,"name":"Mert Demirel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYJACZgYDCx4G9gYg08CCKB2MzQwGEjwMPAdAWiSI1cIAVCmRAOIQoUW3vff544ICCRndmc+vbvhRIMHA396dgFeL2Znjhs0zgA4zu51TdrMH6DCJM2c34NdyI42xmQeiJe0GkAH0Ti4BLfefQbXcPJN28w9RWm6wQbXcYD92mzhbzqQxzgb75UwO220ZIIOwX44fY/hc8MfG3uz48Wc33/yxkeNv78WvBQnwGIBJYpWDAPsDUlSPglEwCkbBCAIArqFDhIwF8fQAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-5175-0480","institution":"Erzurum Regional Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mert","middleName":"","lastName":"Demirel","suffix":""}],"badges":[],"createdAt":"2026-04-22 19:45:22","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9499948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9499948/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107692268,"identity":"d19d7ae0-a340-4b09-9a64-4ed1cc8c5bef","added_by":"auto","created_at":"2026-04-24 06:22:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":8229684,"visible":true,"origin":"","legend":"\u003cp\u003eNeuroimaging findings, clinical course, and ocular motility examination. a Initial brain MRI demonstrating diffusion restriction in the left frontal region (upper row: DWI and ADC images, respectively) and blooming artifact on susceptibility-weighted imaging (SWI) in the superior sagittal sinus (lower left), consistent with thrombosis (lower right). b Clinical course showing headache severity (VAS score) over time, with key events including admission, cerebrospinal fluid (CSF) opening pressure measurements, and onset of left abducens nerve palsy. c Ocular motility examination demonstrating left abducens nerve palsy with impaired lateral gaze. d Follow-up MR imaging demonstrating partial recanalization of the superior sagittal sinus on MR venography (MRV)\u003c/p\u003e","description":"","filename":"Fig1NeurolSci600dpi.png","url":"https://assets-eu.researchsquare.com/files/rs-9499948/v1/891acfe750fa9e66ffa12228.png"},{"id":107707035,"identity":"40ba6292-f575-4b09-9d00-49a2e32f8d9c","added_by":"auto","created_at":"2026-04-24 09:19:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8193454,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9499948/v1/4b5b0e5d-ec9d-48f7-9a49-c38995b969ff.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eUnilateral Abducens Nerve Palsy After Intracranial Pressure Normalization in Postpartum Cerebral Venous Sinus Thrombosis\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"\u003cp\u003eCerebral venous sinus thrombosis (CVST) accounts for approximately 0.5\u0026ndash;1% of strokes in adults and disproportionately affects women, with a reported incidence of roughly 7 per 100,000 deliveries in the postpartum period [1, 2]. Cranial nerve involvement is uncommon; when it occurs, the abducens nerve is most frequently affected because of its long intracranial course and vulnerability to raised intracranial pressure (ICP) [3]. Reported abducens palsies in CVST are typically bilateral and co-occur with elevated ICP. Unilateral abducens palsy emerging during the treatment course\u0026mdash;particularly after ICP has normalized\u0026mdash;is rarely reported and mechanistically poorly understood. To the best of our knowledge, no previous case of unilateral abducens palsy in postpartum CVST has been described.\u003c/p\u003e\n\u003cp\u003eA previously healthy 22-year-old gravida 4, para 4 woman presented on postpartum day 11 with severe headache and left-sided paresthesia. Initial MRI demonstrated diffusion restriction in the left frontal region and superior sagittal sinus thrombosis (Fig. 1a). Fundoscopy showed bilateral grade 1 papilledema. Subcutaneous enoxaparin and acetazolamide (250 mg three times daily) were initiated. A thrombophilia workup\u0026mdash;factor V Leiden mutation, prothrombin G20210A mutation, antiphospholipid antibodies, and protein C/S\u0026mdash;was unremarkable. Lumbar puncture on postpartum day 12 revealed an opening pressure of 360 mmH₂O with otherwise normal CSF constituents. The headache gradually resolved over the following days (Fig. 1b). On postpartum day 17, the patient reported visual impairment; neurological examination disclosed an isolated left abducens nerve palsy (Fig. 1c). A repeat lumbar puncture performed at symptom onset yielded an opening pressure of 210 mmH₂O, and therapeutic drainage was deferred given the normal pressure. To exclude thrombus progression or a new ischemic event, contrast-enhanced magnetic resonance venography (MRV) and diffusion imaging were repeated; these demonstrated no new diffusion restriction in the brainstem or elsewhere and showed partial recanalization of the superior sagittal sinus (Fig. 1d). The patient remained clinically stable with persistent left abducens palsy and no headache on postpartum day 20 and was discharged on enoxaparin. Written informed consent for publication was obtained from the patient.\u003c/p\u003e\n\u003cp\u003eSeveral mechanisms have been proposed for abducens involvement in CVST. Raised ICP producing bilateral, pressure-dependent palsy is the most widely cited and fits classic \u0026ldquo;false localizing sign\u0026rdquo; pathophysiology; bilateral sixth-nerve palsy with papilledema two weeks after cesarean delivery has been reported in this setting [3]. Thrombosis of the inferior petrosal sinus or adjacent venous structures can compress the sixth nerve within Dorello\u0026rsquo;s canal, producing unilateral palsy by direct mass effect [5]; MRV in our patient did not show thrombosis of these structures. Isolated unilateral lateral rectus palsy has also been described in pregnancy-related CVST, although that report concerned antepartum thrombosis of unspecified venous structures rather than superior sagittal sinus thrombosis during active anticoagulation [4].\u003c/p\u003e\n\u003cp\u003eThe clinical trajectory of our patient is distinctive in that abducens palsy emerged after ICP had normalized and during radiological recanalization. This timing argues against ongoing pressure-mediated nerve stretch or direct compressive thrombosis at the time of symptom onset, and instead suggests a delayed injury mechanism. Candidate explanations include venous congestion\u0026ndash;related microvascular ischemia, with impaired oxygen and glucose delivery within the intrinsic vasa nervorum of the abducens nerve, and dynamic changes in transmural pressure as ICP falls while venous outflow is still being restored. A rapid reduction in ICP during treatment may transiently unmask vulnerable segments of the nerve that were previously stabilized by uniformly elevated surrounding pressures. This mechanism is speculative but is consistent with the anatomical course of the abducens nerve, its high metabolic sensitivity, and the delayed, unilateral pattern observed here.\u003c/p\u003e\n\u003cp\u003eSeveral practical lessons emerge. Postpartum patients with acute focal neurological deficits warrant prompt evaluation for CVST, irrespective of atypical features. A new focal deficit appearing during treatment should not be reflexively attributed to thrombotic progression; here, the deficit emerged in the setting of imaging improvement and normalized CSF pressure. Finally, unilateral cranial neuropathy in CVST may reflect mechanisms independent of raised ICP, and recognition of this possibility can avoid unnecessary escalation of anticoagulation or cerebrospinal fluid diversion and guide more measured management.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStam J (2005) Thrombosis of the cerebral veins and sinuses. N Engl J Med 352:1791\u0026ndash;1798. https://doi.org/10.1056/NEJMra042354\u003c/li\u003e\n\u003cli\u003eZhang X, Fang K, Zhang Y, Song J, Wang R, Ji X, Meng R, Zhou D (2025) Cerebral venous thrombosis during pregnancy and postpartum: a systematic review and meta-analysis. Int J Stroke 20:1188\u0026ndash;1200. https://doi.org/10.1177/17474930251355751\u003c/li\u003e\n\u003cli\u003eBuljan K, \u0026Scaron;arić G, Czersky Hafner D, Perković R (2019) Bilateral abducens nerve palsy due to extensive cerebral venous sinus thrombosis. Medicina (Kaunas) 55:115. https://doi.org/10.3390/medicina55040115\u003c/li\u003e\n\u003cli\u003eNandini SA, Sahana R, Mitra R, Venkatesh BS (2023) Central dural venous thrombosis presenting with lateral rectus palsy in pregnancy. Int J Clin Obstet Gynaecol 7:450\u0026ndash;452. https://doi.org/10.33545/gynae.2023.v7.i3d.1349\u003c/li\u003e\n\u003cli\u003eMittal SO, Siddiqui J, Katirji B (2017) Abducens nerve palsy due to inferior petrosal sinus thrombosis. J Clin Neurosci 40:69\u0026ndash;71. https://doi.org/10.1016/j.jocn.2017.02.018\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Erzurum Regional Training and Research Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cerebral venous sinus thrombosis, abducens nerve palsy, postpartum, superior sagittal sinus, intracranial pressure","lastPublishedDoi":"10.21203/rs.3.rs-9499948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9499948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Cerebral venous sinus thrombosis (CVST) disproportionately affects women, with a reported incidence of approximately 7 per 100,000 deliveries in the peripartum period. Abducens nerve palsy in CVST is classically attributed to raised intracranial pressure (ICP) and typically presents as a bilateral false localizing sign. Isolated unilateral involvement emerging after ICP normalization is rarely reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eA previously healthy 22-year-old gravida 4, para 4 woman presented on postpartum day 11 with severe headache and left-sided paresthesia. MRI demonstrated diffusion restriction in the left frontal region, and magnetic resonance venography revealed extensive superior sagittal sinus thrombosis. Opening lumbar \u0026nbsp;puncture pressure was 360 mmH₂O. She was started on therapeutic anticoagulation and acetazolamide. On postpartum day 17, despite documented ICP normalization to 210 mmH₂O and partial radiological recanalization, she developed new-onset left abducens nerve palsy with horizontal binocular diplopia. Examination confirmed isolated left lateral rectus weakness without papilledema or additional cranial nerve deficits. With continued anticoagulation, the palsy gradually resolved over eight weeks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e: The emergence of unilateral abducens palsy after ICP normalization and during radiological recanalization argues against ongoing pressure-mediated traction as the sole mechanism. Alternative explanations include focal ischemic injury to the nerve, localized inflammation at Dorello's canal, or delayed reperfusion-related microvascular dysfunction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: New focal neurological deficits emerging during the recovery phase of postpartum CVST warrant immediate reassessment, including repeat neuroimaging and ophthalmologic evaluation, even when ICP has normalized and radiological recanalization is underway.\u003c/p\u003e","manuscriptTitle":"Unilateral Abducens Nerve Palsy After Intracranial Pressure Normalization in Postpartum Cerebral Venous Sinus Thrombosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 06:22:16","doi":"10.21203/rs.3.rs-9499948/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc42d105-7dc9-46ad-a06f-1f07fb24abc3","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":66840720,"name":"Neurology"}],"tags":[],"updatedAt":"2026-04-24T06:22:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 06:22:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9499948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9499948","identity":"rs-9499948","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}