Delayed-onset bilateral abducens paresis after head trauma

• Main Authors: Pravin Salunke, Amey Savardekar, Sukumar Sura
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2012-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Orbit; proptosis; thyroid; Hyperhomocysteinemia; retinal arterial occlusions; systemic associations; young age; Illumination; letter charts; visual acuity; Dacryocystorhinostomy; intraocular pressure; systemic effects; timolol maleate; Accommodation; dynamic retinoscopy; ophthalmoscopy; photorefraction; photoretinoscopy; Apoptosis; corneal epithelium; formulation; sphingosine-1 phosphate; Digital camera; external photograph; photography; Android; eye handbook; iPhone; smart phone; testing tools; Anterior chamber intraocular lens; gyrate atrophy; posterior dislocation of intraocular lens; psuedophakia; Conjunctival ulcer; conjunctivitis; Stenotrophomonas maltophilia; Adrenergic blocker; imipramine; intraoperative floppy iris syndrome; iris hooks; phacoemulsification; Corneal ectasia; deep anterior lamellar keratoplasty; hexagonal keratotomy; hyperopia; Intravitreal triamcinolone acetonide; retinochoroiditis; toxoplasmosis; Capsulorrhexis; completion rates; pediatric cataract surgery; Complications; knotless scleral fixated intraocular lens; technique; Bilateral abducens nerve; delayed onset paresis; head injury
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2012;volume=60;issue=2;spage=149;epage=150;aulast=Salunke

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.