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Abducens nerve palsy associated with a clival epidural hematoma

Pinar Topcu-Yilmaz1, Michael X Repka

  • 1Zanvyl Krieger Children's Eye Center, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-9028, USA.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|February 15, 2011
PubMed

Insights

A rare clival epidural hematoma in a child, caused by a neck injury, can lead to cranial nerve palsies. This case shows conservative management led to hematoma resolution and partial nerve recovery.

Area of Science:

  • Neurology
  • Pediatric Neurosurgery
  • Trauma Imaging

Background:

  • Clival epidural hematomas (CEHs) are uncommon intracranial lesions.
  • They typically result from neck trauma, particularly hyperflexion/hyperextension injuries.
  • Pediatric cases are infrequent and often associated with significant neurological deficits.

Observation:

  • A 5-year-old female sustained a motor vehicle accident.
  • The patient presented with multiple cranial neuropathies, including bilateral abducens nerve (CN VI) paresis and right-sided cranial nerve palsies (CN VII, IX, XII).
  • Neuroimaging confirmed the presence of a clival epidural hematoma.

Findings:

  • The clival epidural hematoma was managed conservatively with observation.
  • The hematoma demonstrated spontaneous resolution over time.
  • Abducens nerve palsies gradually resolved over a 14-month period.

Implications:

  • Conservative management can be effective for pediatric clival epidural hematomas.
  • Cranial nerve deficits associated with CEH may show significant recovery.
  • This case highlights the importance of neuroimaging in diagnosing traumatic pediatric brain injuries and associated neuropathies.

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