Efficiency of Corticosteroid Treatment in Resolution of Bilateral Abducens Paralysis After Head Trauma

Abstract

A rare case of posttraumatic bilateral abducens palsy is presented. A 17-year-old male patient referred to our clinic because of complaints of diplopia, difficulty in opening his mouth, pain in the face, dyspnea, and chest pain after head trauma from a motor vehicle accident. The patient was not able to abduct eyes bilaterally, and diplopia occurred in the lateral gaze. All other extraocular movement was intact. He also had a mandibular fracture and bilateral pneumothorax. Computed tomography scan of the cranium showed no intracranial or extracranial hemorrhage, no mass effect, and no edema. No abnormalities were seen in the orbits, sinuses, skull base, and calvarium. For the treatment of sixth cranial nerve palsy, we applied corticosteroid therapy and waited for spontaneous recovery. During follow-up, at 3 months after discharge, he showed marked improvement in his ocular mobility and alignment without any residual limitation of abduction bilaterally. A bilateral sixth nerve palsy is rarely seen after a head trauma without cranial pathologic findings, and corticosteroid therapy may have beneficial effects during treatment besides spontaneous resolution.

Cranial Nerve Injuries In Patients With Moderate To Severe Head Trauma – Analysis of 91,196 Patients From The TraumaRegister DGU® Between 2008 And 2017

“…In general, traumatic CNI is less likely to recuperate than cranial nerve impairment in the context of vascular disease [36]. In view of the therapeutic approach to ocular motor CNI, many methods of treatment including surgical correction, botulinum toxin injection, prisms, and steroid medication have been applied and reported apart from observation and watchful waiting [43][44][45][46].…”

Steroids in the Management of Synkinesis after Traumatic Oculomotor Palsy in India

“…10 As a result, steroids are often not given to patients with traumatic brain injuries with Glasgow coma score of 14 or less, which may often be the case in many patients with traumatic cranial nerve palsies. However, in patients with stable and reassuring neurological findings, the use of steroids has been described after traumatic CNIII, 11 traumatic abducens palsy, 12 and traumatic facial nerve palsy, 1 all generally with good results. Steroid use has also been described after presumed inflammatory CNIII palsy secondary to norovirus.…”

“…However, other studies have demonstrated that, if given early enough, the steroids may limit the degree of inflammation and secondary damage to the endoneurium, and thus reduce the rate of aberrant regeneration. [11][12][13] Limitations of our study include its retrospective nature, small number of patients, variable or lacking steroid dosing regimens and timing, variable follow-up, and oculomotor measurements done without prism diopters. This study was not powered for statistical calculations, so no statement about statistical significance can be made.…”