[A case of crushing head injury showing bilateral abducens, facial and acoustic nerve palsies]

Abstract

Most head injuries are due to two basic mechanisms, contact or acceleration. On the other hand, static loading force makes another type of head injury, so called "crushing head injury". In this report, we discussed the mechanism of the crushing head injury and cranial nerve damage of our case. A 35-year-old male was admitted to our hospital suffering from a crushing head injury. In this accident, his head had been crushed between 1000-kg printing machine and truck bed on both temporal regions slowly. He remained fully conscious. On admission 25 minutes after the injury, he showed bilateral sixth-nerve, seventh-nerve palsies, bilateral hearing loss and obvious bleeding from nares and both ears. Gross motor examination was intact. Skull films demonstrated left temporal linear fracture. CT scan showed remarkable pneumocephalus in the basal cistern but no other intracranial lesions. At discharge, two weeks after the trauma, the patient was alert and remained bilateral sixth-nerve, seventh-nerve palsies, and bilateral hearing loss. At the time of 6 months after the initial injury, bilateral abducens nerve palsies and left facial nerve palsy were improved completely. But he demonstrated right slight facial nerve palsy and bilateral moderate hearing loss continuously. In this rare type of injury, the head of the patients had been crushed slowly by the huge power on both temporal regions. This force makes the avulsion of the petrous bone from the foramen lacerun to the outer side of the bone (Russell WR and Schiller F, 1949). This must tend to stretch the sixth nerve and produce abducens nerve injury.(ABSTRACT TRUNCATED AT 250 WORDS)