Images Post-Traumatic Diplopia A

Federico Greco, Carlo Mallio, Lorenzo Sabatino, Yuri Errante, Manuele Casale, Carlo Quattrocchi, Bruno Beomonte Zobel, Greco Federico
_____________________________________________________________________________________ 52-year-old woman was admitted to our radiology department to perform a brain magnetic resonance imaging (MRI) examination. One month before, she had been involved in a multi-vehicle accident with amyelic C2-C3 anterior spondilolisthesis associated to bilateral pedicle fracture of C2, treated conservatively with halo jacket. Multiple left-side ribs fractures with associated ipsilateral pneumothorax, left
more » ... and left ulnar fractures were also diagnosed and treated. Brain computed tomography scan, performed in the emergency department, showed no abnormalities. On examination, binocular horizontal diplopia greater in right gaze, suggestive for right lateral rectus muscle palsy, was observed. No other neurological motor, sensory or sphincterial deficits were present. Brain MRI showed absence of right VI cranial nerve (Figure1, panel A). No brain supra-or infra-tentorial abnormalities were present. Fig1: Axial TSE 3D SPACE sequence (panel A) and coronal T2 fat suppressed TSE sequence (panel B). In the pre-pontine cistern, the absence of the cisternal tract of the right abducens nerve is shown (Panel A, arrow), conversely, the left abducens nerve is normal. Asymmetry of eye muscles with reduction in thickness of the right lateral rectus muscle (Panel B, arrow).