Isolated abducens nerve palsy following temporal bone fracture in a child

Abstract

Temporal bone fractures are often associated with damage to middle or inner ear structures, facial nerve, and cerebrospinal fluid (CSF) leak, and rarely with abducens nerve palsy. Isolated abducens nerve palsy is not known to occur following temporal bone fracture and is most commonly associated with concurrent facial nerve injury. We report a case of an 11-year-old girl who presented with isolated right abducens nerve palsy following head trauma. The child had incurred injury following a fall from a bicycle. The presence of postauricular ecchymosis was suggestive of possible temporal bone fracture. High-resolution computed tomography scan revealed undisplaced fracture of the right temporal bone at the petrous apex. Identification of temporal bone fracture prompted toward complete neurological and otological evaluation to detect life-threatening complications like CSF otorrhea. The child was managed conservatively with occlusion therapy to alleviate diplopia and showed complete resolution of the nerve palsy after 4 months. Isolated abducens nerve palsy following the temporal bone fracture is a rare finding. Additional clinical findings like postauricular ecchymosis should be looked for, and appropriate otological evaluation sought in such cases.

Keywords

• abducens nerve palsy
• cranial nerve injury
• pediatric trauma
• temporal bone fracture