Isolated Bilateral Abducens Nerve Palsy after Closed Head Trauma in an 11-year-old Boy

摘要

An 11-year-old boy presents to the pediatric emergency department after being hit as a pedestrian by a car in a motor vehicle crash. The patient reports no loss of consciousness and notes nonspecific chest pain and headache.On physical examination, his blood pressure is 123/64 mm Hg, heart rate is 82 beats/rnin, respiratory rate is 18 breaths/min, and oxygen saturation is 98%. He is conscious, is initially unable to talk due to pain, but is able to follow instructions and localize pain. He has significant abrasions to his face and scalp, blood-tinged clear drainage from both ears, and palpable tenderness along the subcostal margins of the chest. Findings from initial neurologic examination are normal, with a Glasgow Coma Scale score of 15 of 15, normal pupillary reflexes, a full range of ocular movements, and normal motor and sensory examination findings. Results of laboratory studies are normal. A chest radiograph shows normal heart and lung fields.