Isolated abducens nerve involvement as a revealing sign of temporal bone fracture: A case report

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.