[A case of divergence palsy associated with bilateral chronic subdural hematoma]

A surgical case of bilateral chronic subdural hematoma presenting with divergence palsy is reported. A 75-year-old female was admitted to hospital for investigation of 2-week history of diplopia. The initial neurological examination demonstrated no abnormal findings except Hess chart suggesting bilateral concomitant strabismus or paresis of lateral rectus on both eyes. Because of the homonymous diplopia disappeared when the object of fixation in brought closer and the patient showed no impairment of gaze movements and following movements, the patient was diagnosed as divergence palsy and referred to the Neurosurgical Service. The physical examination revealed a 75-year-old, alert, fully oriented with diplopia at distant gaze. A computerized tomographic (CT) scan showed bilateral subdural hematoma. Emergency burrhole evacuation was performed and total amount bilateral hematoma was 220ml. Diplopia disappeared postoperatively. Hess chart examined two months after the operation shows no impairment of divergence function. This is the first reported case of divergence palsy associated with bilateral chronic subdural hematoma in CT era.