Multiple cranial nerve palsies after head injury. A case report

Injuries to the third fourth, sixth and seventh cranial nerves are common after head injury and may be missed during the initial assessment. Bilateral palsies of the third fourth and sixth nerves are also rare. We report a case of a 16-year-old male having bilateral third (partial), bilateral fourth, bilateral sixth and right lower motor neuron (LMN) facial nerve palsy after severe head injury. The only ocular movement patient was able to perform was adduction of the left eye. His CT scan revealed pneumocephalus (frontal and around the brain stem) and a midbrain contusion. He was managed conservatively. These palsies gradually improved over two years.