Ocular manifestations uncover chronic subdural hematoma secondary to abuse

An abduction deficit or cranial nerve VI palsy can have many potential etiologies. However, a cranial nerve VI palsy in the setting of disc edema suggests increased intracranial pressure, requiring emergent work-up.

An 18-year-old woman presented with significant headaches and horizontal diplopia, which she claimed began after giving birth 3 months prior. Her examination found a right cranial nerve VI palsy and mild disc edema of the left eye. This combination of findings was suggestive of increased intracranial pressure. Emergent workup uncovered a large chronic subdural hematoma requiring immediate neurosurgical intervention. She ultimately admitted to being abused by her partner.

Diplopia and disc edema in a young, nonoverweight patient with an altered mental state is very concerning. Meningitis and complications of spinal anesthesia, although rare, need to be considered in patients who have recently given birth. However, other causes of increased intracranial pressure, including subdural hemorrhage secondary to trauma, also have to be considered, even if the patient denies any history of trauma. Abused patients often deny trauma.