Post-traumatic Unilateral Avulsion of the Abducens Nerve with Damage to Cranial Nerves VII and VIII: Case Report

A Case of Unilateral Sixth Cranial Nerve (CN VI) Avulsion in the Prepontine Cistern After Severe Head Trauma

The patient was a 46-year-old woman who presented with right sixth cranial nerve (CN VI) palsy following severe head trauma secondary to a motor vehicle collision one month prior. In this case report, we aim to add to the literature an additional example of unilateral CN VI avulsion as visualized by MRI secondary to head trauma. 3D T2 MRI was used to visualize the CN VI avulsion. CT was also used in the evaluation of head trauma. In our view, the force trajectory of the patient's impact with the vehicle dashboard, as evidenced by the right occipital lobe fracture, explains the etiology of the unilateral right CN VI avulsion. The combination of clinical and imaging findings was central to the analysis of this case.

Transient Bilateral Sixth Nerve Palsy: A Rare Sequela of Head Trauma

Sixth cranial nerve palsy is uncommon but a well-recognized consequence of head trauma. Although few cases documented traumatic persistent bilateral sixth nerve palsy, a transient episode is extremely rare and not reported before. We report an unusual case of transient bilateral abducens nerve palsy after minor head trauma, which was completely resolved without any intervention after 20 min. Diplopia may relate to anatomical lesion, and even transient diplopia can guide us to a serious anatomical lesion that may occur. CT scan of the head revealed a left nondisplaced occipital fracture, which extends to the left petrous bone. The patient was admitted for 24-h observation and discharged home on paracetamol. This case emphasizes the need to recognize the rare sequences of minor head trauma and manage them appropriately.