Belkacemi Abdelmonim, Azouaghe Youssef, Bouchlarhem Saad, Sbai Achraf Amine, Benfadil Drissia, Lachkar Azeddine, El Idrissi Fahd El Ayoubi
Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.
Department of Otorhinolaryngology, Mohammed VI University Hospital Mohammed I University, Oujda, Morocco.
Radiol Case Rep. 2025 Jun 21;20(9):4483-4487. doi: 10.1016/j.radcr.2025.05.069. eCollection 2025 Sep.
Isolated abducens nerve palsy is an uncommon yet clinically significant manifestation of temporal bone fracture, often following blunt head trauma. We report the case of a 52-year-old woman who sustained a right-sided head injury after a domestic fall under the influence of alcohol. She presented with diplopia, vertigo, and right-sided conductive hearing loss. Clinical examination revealed impaired abduction of the right eye, anisocoria with mydriasis, right retroauricular ecchymosis, and facial hypoesthesia in the maxillary (V2) and mandibular (V3) territories. Otoscopy showed hemotympanum, and audiometry demonstrated a 60 dB conductive hearing loss with absent stapedial reflexes. Videonystagmography revealed a 30% vestibular deficit on the right side. High-resolution CT imaging showed a longitudinal fracture of the right temporal bone extending to the petrous apex, with associated incudomalleolar dislocation and hemotympanum. The abducens nerve palsy was attributed to traumatic stretching or compression near Dorello's canal, in proximity to the petrous ridge. Surgical ossiculoplasty was performed to repair the disrupted ossicular chain. This case underscores the importance of meticulous imaging evaluation in patients with skull base trauma and cranial nerve palsies, particularly when radiological findings may guide both the diagnosis and therapeutic approach.
孤立性展神经麻痹是颞骨骨折一种不常见但具有临床意义的表现，常继发于钝性头部外伤。我们报告一例52岁女性病例，该患者在酒精影响下在家中摔倒后右侧头部受伤。她出现复视、眩晕和右侧传导性听力损失。临床检查发现右眼外展受限、瞳孔不等大伴瞳孔散大、右耳后瘀斑以及上颌（V2）和下颌（V3）区域面部感觉减退。耳镜检查显示鼓室积血，听力测定显示传导性听力损失60 dB且镫骨肌反射消失。视频眼震图显示右侧前庭功能减退30%。高分辨率CT成像显示右侧颞骨纵行骨折延伸至岩尖，伴有砧镫关节脱位和鼓室积血。展神经麻痹归因于靠近岩嵴的Dorello管附近的创伤性牵拉或压迫。进行了手术听骨成形术以修复中断的听骨链。该病例强调了对头颅底外伤和颅神经麻痹患者进行细致影像评估的重要性，尤其是当影像学结果可指导诊断和治疗方法时。
