Efficiency of corticosteroid treatment in resolution of bilateral abducens paralysis after head trauma.

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.