Delayed bilateral abducens nerve palsy after head trauma

A Case Report of Bilateral Abducens Palsy in the Setting of Clival Fracture - Recovery Related to Pathophysiological Basis of Injury

Head trauma resulting in clival fracture and bilateral abducens palsy is uncommon. We depict a case of bilateral abducens palsy in a 45-year-old man who, following a period of conservative management showed unilateral improvement in function which was correlated to magnetic resonance imaging findings. We review the anatomical relations of the abducens nerve as well as the potential mechanisms and pathophysiological basis for its compromise in the setting of trauma.

Bilateral traumatic abducens nerve avulsion: A case series and literature review

Although abducens nerve palsy is an established sequela of head trauma - given the prolonged intracranial course of the nerve - bilateral injury is rare. Here, we present two cases of bilateral traumatic abducens nerve avulsion, in the absence of regional fractures, one of which presented two months following the initial trauma. Additionally, we review the current literature on bilateral abducens nerve palsy secondary to trauma, discussing the anatomy of the nerve's course and potential mechanisms of injury.

A 3-year review of cranial nerve palsies from the University of Port Harcourt Teaching Hospital Eye Clinic, Nigeria

Purpose:

To provide the types, frequency and clinical information on common cranial nerve palsies seen at the Eye Clinic at the University of Port Harcourt Teaching Hospital.

Materials and Methods:

A chart review was performed of patients who presented with cranial nerve palsy at the Eye Clinic over a 3-year period (January 2009-December 2011). Data were collected on age, sex, type of cranial nerve palsy, a history of systemic disease such as diabetes mellitus (DM), hypertension and cerebrovascular disease. Exclusion criteria included medical charts with incomplete data. Data was analyzed using Epi-info Version 6.04D. Statistical significance was indicated by P < 0.05.

Results:

Twenty-four patients had cranial nerve palsies. There were 11 males and 13 females with a mean age of 34.50 ± 18.41 years. Four patients (26.6%) had exotropia while three patients (20%) had esotropia. Complete ophthalmoplegia was noted in two patients (13.3%). The 3^rd and 6^th cranial nerves were affected in seven patients each (29.2%) and five patients (20.8%) had 7^th cranial nerve palsy. Approximately 38% of patients with cranial nerve palsies had systemic disorders (16.7% systemic hypertension; 12.5% DM). The relationship between cranial nerve palsy and systemic disorder was statistically significant (P < 0.01).

Conclusion:

This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6^th cranial nerve palsy.

A case of traumatic bilateral abducens and unilateral hypoglossal nerve palsy

Patient: Female, 47

Final Diagnosis: Traumatic bilateral abducens • unilateral hypoglossal nerve palsy

Symptoms: Diplopia

Medication: —

Clinical Procedure: —

Specialty: Neurology

Objective: Rare disease

Delayed-onset bilateral abducens paresis after head trauma

Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

Delayed post-traumatic bilateral abducens nerve palsy with complete recovery

Isolated bilateral abducens (sixth) nerve palsy is rare in the setting of trauma. To date, most cases have been reported in patients who sustain cranial fractures or have other acute intracranial pathologies, including acute hemorrhage. We describe the case of a 41-year-old man who presented with bilateral abducens nerve palsy in the setting of acute head trauma without evidence of cranial fractures or other acute intracranial pathology. Six months after the initial injury, he regained bilateral function of his abducens nerves with intact extraocular muscle movements. Full recovery is the natural history in the majority of traumatic abducens nerve palsies, and this is an important consideration when counseling patients with such injuries.