Delayed-onset bilateral abducens paresis after head trauma

Area of Science:

• Neuroscience
• Ophthalmology
• Traumatology

Background:

• Bilateral sixth nerve (abducens nerve) paresis is a recognized, albeit uncommon, consequence of closed head injury.
• Delayed-onset presentation of this condition following traumatic brain injury is exceptionally rare.

Observation:

• Two cases of delayed-onset bilateral abducens nerve paresis following closed head injury are presented.
• The first case manifested 2 weeks post-injury, attributed to a chronic subdural hematoma.
• The second case appeared 3 days post-injury, with edema or ischemia of nerve-housing soft tissues speculated as the cause.

Findings:

• The temporal delay in the onset of bilateral abducens paresis appears to correlate with the underlying etiology.
• Mechanisms beyond direct trauma, such as increased intracranial pressure, may contribute to this delayed paresis.
• Chronic subdural hematoma was identified as a cause in one patient.

Implications:

• Delayed-onset bilateral abducens paresis post-head injury warrants thorough investigation due to potentially treatable causes.
• Evaluation for elevated intracranial pressure should be considered in such cases.
• Understanding varied injury mechanisms is crucial for managing post-traumatic cranial nerve palsies.