Management of bilateral oculomotor paralysis after traumatic head injury: a case report

A 73-year-old male with disabling torticollis. He suffered a severe traumatic head injury when he had 36 years old, affecting multiple cranial nerves, including III, IV and VI bilaterally. On actual examination he presented a large torticollis left head turn that compensates the diplopía. In the right eye, -4 limitation of adduction, -1 limitation of elevation and horizontal nystagmus on abduction. In the left eye, -6 limitation of abduction, -2 limitation of adduction, -1 limitation of elevation and -2 limitation of depression (0-8 scale). The right eye underwent Nasal Nishida procedure and the left eye underwent a Temporal Nishida. One year after the surgery the patient was no longer maintaining a head turn but had a mild tilt to the right and inttermitent diplopía. Nishida procedure can be a good option in cases of complex bilateral oculomotor paralysis.