[Unilateral traumatic temporal lesions and secondary involvement of the 3d cranial nerve. Role of medical treatment].

Four cases of unilateral traumatic cerebral lesion with secondary third nerve palsy are reported. These four cases were observed over the course of one year and represent 5% of all unilateral traumatic cerebral lesion observed in our department during that period. The clinical situation presumptive of tentorial herniation included: partial (2 patients) or total (2 patients) secondary third nerve palsy, homolateral to the cerebral lesion; noncomatose state with initial Glasgow verbal score of 3 or greater; slight or no contralateral deficit. The anatomic lesions are unilateral and included 2 cases of temporal hematoma, one case of hemispheric swelling with acute subdural hematoma, and one case of general brain edema with temporal hematoma; In all 4 cases the clinical course was favorable with medical treatment alone. Based on the clinical information (non comatose state) and CT-scans (basal cisterns present or slight compressed in 3 of 4 cases), the authors believe that there was no tentorial herniation; third nerve palsy occurred without axial compression. The authors analysed several of the accepted criteria for severe head injuries (GCS, CT-scan, and ICP) and referred to the literature in order to determine optimal patient management in such reversible situations that posed a danger of tentorial herniation. Repeated clinical examination and CT-scan for visualization of basal cisterns appeared to be the best criteria for therapeutic decision.