Images in Clinical Medicine

Traumatic Cranial Nerve Palsy

Christopher Baker, M.D., and Jeremy Cannon, M.D.

N Engl J Med 2005; 353:1955November 3, 2005

Slide

Article

A 19-year-old man sustained a crush injury to his skull from a piece of heavy machinery. Although on initial assessment he readily followed commands, his mental status deteriorated and he required intubation for airway protection. He was rapidly transferred to our level 1 trauma center. An examination of his pupils at his arrival showed ptosis (Panel A) and anisocoria (Panel B), which aroused concern that there was uncal herniation. A high-resolution computed tomographic scan of his head did not show uncal herniation but, rather, revealed a complex fracture of the sella turcica (Panel C, arrow) and of the skull base (not shown), with impingement of the bony nerve canals and a C1 fracture. He was discharged to his home 16 days after the injury with a hard cervical collar. Subsequently, he has done well but has had occasional vertigo and tinnitus. His ocular defects have resolved.

Christopher Baker, M.D.
Jeremy Cannon, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215

Citing Articles (1)