Bilateral pupil-sparing oculomotor nerve paralysis with multiple cranial nerve palsies and hormonal imbalance following head trauma. Report of a rare case with clinicopathologic correlation

Abstract

Isolated third nerve palsy alone or in combination with other cranial nerve palsies is a known phenomenon following moderate to severe closed head injuries Isolated or combined third nerve palsy is almost always associated with pupillary involvement. A twenty-five-year-old male was admitted following head trauma at a private hospital where he remained unconscious for few hours. On recovery, he had bilateral ptosis with third nerve paralysis, bilateral sixth nerve paralysis, infranuclear facial palsy on left side and sensory impairment over right side of face. Initial CT head showed pneumocephalous in basal cisterns. MRI brain showed fluid in pituitary fossa and sphenoid sinus with contusion of optic chiasma. Hormonal profile revealed decreased T3, T4 and TSH levels and gonadotropin levels. We suggest spiral CT and MRI along with hormonal assessment of all the cases for accurate assessment of bony and neurological involvement in patients of head trauma with multiple cranial nerve palsies and injury in the region of sphenoid sinus.

Keywords

cranial nerves - head trauma - oculomotor nerve palsy

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