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Delayed Bilateral Abducens Nerve Palsy after Head Trauma

  • Kim, Min-Su (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Cho, Min-Soo (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Kim, Seong-Ho (Department of Neurosurgery, College of Medicine, Yeungnam University)
  • Published : 2008.12.31

Abstract

Although the incidence of unilateral abducens nerve palsy has been reported to be as high as 1% to 2.7% of head trauma cases, bilateral abducens nerve palsy following trauma is extremely rare. In this report, we present the case of a patient who developed a bilateral abducens nerve palsy and hypoglossal nerve palsy 3 days after suffering head trauma. He had a Glasgow Coma Score (GCS) of 15 points. Computed tomography (CT) images demonstrated clivus epidural hematoma and subarachnoid hemorrhage on the basal cistern. Herein, we discuss the possible mechanisms of these nerve palsies and its management.

Keywords

References

  1. Advani RM, Baumann MR : Bilateral sixth nerve palsy after head trauma. Ann Emerg Med 41 : 27-31, 2003 https://doi.org/10.1067/mem.2003.46
  2. Arcand G, Girard F, McCormack M, Chouinard P, Boudreault D, Williams S : Bilateral sixth cranial nerve palsy after unintentional dural puncture. Can J Anaesth 51 : 821-823, 2004 https://doi.org/10.1007/BF03018456
  3. Arias MJ : Bilateral traumatic abducens nerve palsy without skull fracture and with cervical spine fracture : a case report and review of the literature. Neurosurgery 16 : 232-234, 1985 https://doi.org/10.1227/00006123-198502000-00020
  4. Baker RS, Epstein AD : Ocular motor abnormalities from head trauma. Surv Ophthalmol 35 : 245-267, 1991 https://doi.org/10.1016/0039-6257(91)90046-I
  5. Berlit P, Reinhardt-Eckstein J, Krause KH : [Isolated abducens paralysis : a retrospective study of 165 patients.] Fortschr Neurol Psychiatr 57 : 32-40, 1989 https://doi.org/10.1055/s-2007-1000743
  6. Calisaneller T, Ozdemir O, Altinors N : Posttraumatic acute bilateral abducens nerve palsy in a child. Childs Nerv Syst 22 : 726-728, 2006 https://doi.org/10.1007/s00381-005-0036-9
  7. Demisch S, Lindner A, Beck R, Zierz S : The forgotten condyle : delayed hypoglossal nerve palsy caused by fracture of the occipital condyle. Clin Neurol Neurosurg 100 : 44-45, 1998 https://doi.org/10.1016/S0303-8467(97)00111-X
  8. Dhaliwal A, West AL, Trobe JD, Musch DC : Third, fourth, and sixth cranial nerve palsies following closed head injury. J Neuroophthalmol 26 : 4-10, 2006 https://doi.org/10.1097/01.wno.0000204661.48806.1d
  9. Dukes IK, Bannerjee SK : Hypoglossal nerve palsy following hyperextension neck injury. Injury 24 : 133-134, 1993 https://doi.org/10.1016/0020-1383(93)90209-O
  10. Hollis GJ : Sixth cranial nerve palsy following closed head injury in a child. J Accid Emerg Med 14 : 172-175, 1997 https://doi.org/10.1136/emj.14.3.172
  11. Holmes JM, Droste PJ, Beck RW : The natural history of acute traumatic sixth nerve palsy or paresis. J AAPOS 2 : 265-268, 1998 https://doi.org/10.1016/S1091-8531(98)90081-7
  12. Kobayashi S, Yokota H, Nakazawa S : [A case of crushing head injury showing bilateral abducens, facial and acoustic nerve palsies.] No Shinkei Geka 16 : 869-873, 1988
  13. Marconi F, Parenti G, Dobran M : Bilateral traumatic abducens nerve palsy. Case report. J Neurosurg Sci 38 : 177-180, 1994
  14. Muthukumar N : Delayed hypoglossal palsy following occipital condyle fracture--case report. J Clin Neurosci 9 : 580-582, 2002 https://doi.org/10.1054/jocn.2001.1067
  15. Mutyala S, Holmes JM, Hodge DO, Younge BR : Spontaneous recovery rate in traumatic sixth-nerve palsy. Am J Opthalmol 122 : 898-899, 1996 https://doi.org/10.1016/S0002-9394(14)70394-0
  16. Oh JG, Lee SJ, Kim EK, Moon BG, Kang HI, Kim JS : Bilateral traumatic abducens nerve palsy associated with Hangman's fracture : case report. J Korean Neurosurg Soc 31 : 188-191, 2002
  17. Orbay T, Aykol S, Seckin Z, Ergun R : Late hypoglossal nerve palsy following fracture of the occipital condyle. Surg Neurol 31 : 402-404, 1989 https://doi.org/10.1016/0090-3019(89)90076-1
  18. Ozveren MF, Uchida K, Aiso S, Kawase T : Meningovenous structures of the petroclival region : clinical importance for surgery and intravascular surgery. Neurosurgery 50 : 829-836; discussion 836- 837, 2002
  19. Pinches E, Thompson D, Noordeen H, Liasis A, Nischal KK : Fourth and sixth cranial nerve injury after halo traction in children : a report of two cases. J AAPOS 8 : 580-585, 2004 https://doi.org/10.1016/j.jaapos.2004.08.002
  20. Sam B, Ozveren MF, Akdemir I, Topsakal C, Cobanoglu B, Baydar CL, et al : The mechanism of injury of the abducens nerve in severe head trauma : a postmortem study. Forensic Sci Int 140 : 25-32, 2004 https://doi.org/10.1016/j.forsciint.2003.11.020
  21. Takagi H, Miyasaka Y, Kuramae T, Ohwada T, Tsunoda M : [Bilateral traumatic abducens nerve palsy without skull fracture or intracranial hematoma : a report of 3 cases and consideration of the mechanism of injury.] No Shinkei Geka 4 : 963-969, 1976
  22. Turner JWA : Indirect injuries of the optic nerve. Brain 66 : 150-151, 1943
  23. Urculo E, Arrazola M, Arrazola M Jr, Riu I, Moyua A : Delayed glossopharyngeal and vagus nerve paralysis following occipital condyle fracture : case report. J Neurosurg 84 : 522-525, 1996 https://doi.org/10.3171/jns.1996.84.3.0522
  24. Yamashita K, Kobayashi S, Oguro H, Yamaguchi S : [A case of abducens nerve palsy after whiplash injury.] No To Shinkei 47 : 286-288, 1995

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