Uszkodzenia nerwów II, III, IV, VI, VII po zamkniętych urazach głowy
Damage to the Cranial Nerves II, III, IV, VI, VII following Closed Head Trauma
Anna Kubatko-Zielińska, Anna Piwowarczyk, Mirosław Czarnocki, Bożena Romanowska-Dixon, Anna Klonowska, Małgorzata Werenowska-Pietrzyk, Monika Gedliczka
Katedra i Klinika Okulistyki Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie Pracownia Patofizjologii Widzenia i Neurookulistyki Kierownik: dr hab. n. med. Bożena Romanowska-Dixon
Summary: Purpose of the
study was to assess the frequency of cranial nerves
damage (II, III, IV, V,VII) following head trauma and to
examine, how often patients with those palsies required
Material and methods: In our study we examined 71 patients, 18 women and 53 men at the age of 7-71 years (mean 33.3 years). Patients were treated between 1989-2004 for cranial nerve damage following head trauma. All patients underwent ophthalmic examination. Patients with diagnosed orbit fracture were excluded from our study.
Results: In 28 cases we observed damages involving IV nerve, in 25 - III nerve, in 19 - VI and in 5 cases - II and in 5 cases - VII nerve. Most patients demonstrated isolated nerve damage, 12 presented 2 or 3 nerve damage ipisilaterally and in 3 cases - bilateral palsy was observed. Diplopia was observed in all cases with oculomotor nerve palsy. Four patients had diplopia following decompensated heterophory. In most cases of motor nerve palsies we observed improvement after conservative treatment (n. IV 75%, n. III 60%, n. VI 37%). Several patients were treated with botulinum toxin A, usually in the third month of palsy. Surgical treatment was required in IV nerve damage in 11%, III nerve in 12%, in VI nerve in 11%.
Conclusions: It was road accidents and fights that were the most common cause of cranial nerve damages. In most cases of III, IV, VI, VII nerves palsies we observed improvement after conservative treatment, 10% of patients with oculomotory nerves lesions required surgical treatment.
Keywords: posttraumatic II, III, IV, VI, VII nerves damage, conservative treatment, surgical treatment.