[Traumatic bilateral oculomotor nerve palsy: a case report]

A 28-year-old woman, with no past medical history, was admitted soon after a motor vehicle accident on March 1, 1990. On admission there were multiple small wounds in the right temporal region, but no wounds around the orbits. She was semicomatose with bilaterally fixed dilated pupils (6mm) and ptosis. The eyes were abducted bilaterally. No other cranial nerve palsy was noted. She moved four limbs spontaneously. No skull fracture was present on X-ray films. Cervical X-ray films revealed straightened cervical vertebral column but no fracture. Pelvic bone X-ray films demonstrated fracture and diastasis of the pubic bone. A computed tomography scan demonstrated a small subdural or subarachnoid hemorrhage in the right ambient cistern. A magnetic resonance imaging (MRI) carried out 12 days after trauma demonstrated bilateral small subdural hematomas under the cerebellar tentorium and contusional lesions of the bilateral medial temporal lobes. There were no abnormalities present in the brain stem. The patient was treated conservatively with diuretics and steroids. Disturbance of consciousness gradually improved until one month after the trauma, when she came close to being alert. Bilateral ptosis cleared after 3 months, and adduction of the eyes recovered after 6 months. Vertical eye movement improved a little in 6 months. Fixed 6mm pupils changed to fixed 4mm pupils in 6 months. Bilateral traumatic oculomotor palsy is a rarely described condition, and its mechanism remains conjectural. We discussed the mechanism of the injury and the site of the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)