[A 4-year-old girl with double vision following trauma]

Maaike M van Berkel1, Nicole I Wolf2, Stephanie J N van de Ven3

  • 1Amsterdam UMC, afd. Kindergeneeskunde, Amsterdam.

Insights

Head trauma can cause temporary abducens nerve paralysis, leading to double vision. This condition in children often resolves favorably with monitoring, even without visible brain abnormalities on imaging.

Area of Science:

  • Neurology
  • Ophthalmology
  • Pediatrics

Background:

  • The abducens nerve (cranial nerve VI) is susceptible to injury due to its lengthy intracranial path.
  • Acceleration head injuries can rarely result in post-traumatic abducens nerve paralysis.

Observation:

  • A 4-year-old girl presented with head trauma, initially showing no focal neurological deficits.
  • Three days post-trauma, she developed diplopia secondary to isolated abducens nerve paralysis.
  • Cranial CT and MRI scans revealed no intracranial abnormalities.

Findings:

  • Isolated abducens nerve paralysis can manifest up to six days after head trauma.
  • Imaging studies may not detect associated intracranial abnormalities.
  • Prognosis for pediatric abducens nerve paralysis following trauma is generally favorable, with symptom resolution in most cases.

Implications:

  • This case highlights a rare but potentially reversible cause of pediatric diplopia after head injury.
  • Emphasizes the importance of ophthalmological and orthoptic follow-up for suspected post-traumatic cranial nerve palsies.
  • Suggests conservative management and symptomatic treatment for diplopia may be effective.

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