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[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.
Abstract:
BACKGROUND Due to its long intracranial course, the abducens nerve is vulnerable in case of acceleration injury of the head. In rare cases, this may lead to posttraumatic paralysis of this cranial nerve. CASE DESCRIPTION A 4-year-old girl visited the emergency department after sustaining a head trauma. Neurological examination revealed no focal abnormalities at first. Three days later, she experienced diplopia, the consequence of isolated abducens nerve paralysis. CT and MRI brain imaging revealed no abnormalities. We treated her with an eye patch for a short time. At examination after 1 year, she was no longer experiencing any symptoms and the paralysis had almost completely disappeared. CONCLUSION Isolated paralysis of the abducens nerve may occur until up to 6 days after a trauma, without any visible intracranial abnormalities revealed by imaging. Even though only few children with this condition have been described, prognosis seems to be favourable and symptoms disappear in the majority of patients. Frequent follow-up by the ophthalmologist and the orthoptist is recommended, possibly with symptomatic treatment of the diplopia.
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