İsmail BOYRAZ, Bünyamin KOÇ, Hakan SARMAN, Mansur Kürşad ERKURAN

Kafa travmasından sonra gelişen bilateral abdusens ve sağ fasiyal sinir paralizisi

Nervus abdusens lezyonu yaralanmaya eğilimi nadir olup genelde aniden gelişen kafa travmasından sonra meydana gelmektedir. 11.01.2014 tarihinde iş kazasına bağlı yüksekten düşme hikayesi olan 43 yaşında bir hasta sunduk. Kraniyal tomografisinde bilateral epidural hematom saptanmıştı. Epidural hematom cerrahi olarak boşaltıldı. Cerrahiden sonraki göz muayenesinde bilateral lateral bakış kısıtlılığı dışında görme kaybı saptanmadı. Diplopi nedeniyle hasta yürüyemeyince hastaya tek gözünü kapatması tavsiye edildi. Sağ yüzünde santral fasiyal sinir ve bilateral abdusens sinir paralizisi bulguları vardı. Kafa travmasından sonra birden fazla kraniyal sinir hasarı olabilir. Bu yüzden tüm kraniyal sinir muayeneleri ayrıntılı biçimde yapılmalıdır

Anahtar Kelimeler:

kraniyal sinir, abdusens paralizi, fasiyal paralizi

Bilateral abducens nerve and right facial nerve palsy occuring after head trauma

Lesions of the nervus abducens, the 6th cranial nerve tend to be rare, usually occur suddenly following head injuries. A 43-year-old male patient presented with a history of fall from a height due to an occupational accident on the date of 11.01.2014. Cranial tomography demonstrated bilateral epidural hematoma. The epidural hematoma was drained during the operation. After the surgery, eye examination showed no vision loss, except limited bilateral lateral gaze. When the patient was unable to walk due to diplopia, he was advised to close one eye. On the right side, there were findings suggesting central facial paralysis. There may be multiple cranial nerve damage following head injury. Therefore, all cranial nerves should be thoroughly examined.

Keywords:

cranial nerve, abducens palsy, fascial paralysis,

PDF

___

Ranjiv M. Advani, Michael R. Baumann. Bilateral Sixth Nerve Palsy After Head Trauma. Ann Emerg Med 2003; 41:27-31.
Arias MJ. Bilateral traumatic abducens nerve palsy without skull fracture and with cervical spine fracture: case report and review of the literature. Neurosurgery 1985; 16:232-234.
Ayberk G, Özveren MF, Yıldırım T, Karabekir E, Çay EK, Koçak A. Review of a Series with Abducens Nerve Palsy. Turkish Neurosurgery 2008; 18(4):366-373.
Goodwin D. Differential diagnosis and management of acquired sixth cranial nerve palsy. Optometry 2006; 77:534-539.
Limnaios EE, Papageorgiou CT. Bilateral abducens ner- ve palsy. Ophthalmologica. 1980; 181:326-329.
Sam B, Ozveren MF, Akdemir I, Topsakal C, Cobanoglu B, Baydar CL, et al. The mechanism of injury of the abducens nerve in severe head trauma: a postmortem study. Forensic Sci Int 2004; 140:25-32.
Ozveren MF, Uchida K, Erol FS, Tifitkci MT, Cobanoglu B, Kawase T. Isolated abducens nerve paresis associ- ated with incomplete Horner’s syndrome caused by petrous apex fracture. Neurol Med Chir 2001; 41:494- 496.
Uzan M, Hancı M, Sarıoğlu AÇ, Kaynar MY, Bozkuş H. Bilateral traumatic abducens nerve paralysis with cer- vical spine flexion injury. Eur Spine J 1996; 5:275-277.
Baker RS, Epstein AD. Ocular motor abnormalities from head trauma. Surv Ophthalmol. 1991; 35:245- 267.
Traboulsi EI. Congenital abnormalities of cranial nerve development: Overwiev, molecular mechanisms, and further evidence of heterogeneitiy and complexity of syndromes with congenital limitation of eye move- ment. Trans Am Ophthalmol Soc 2004; 102:373-389.