Korean J Ophthalmol.  2010 Dec;24(6):377-379. 10.3341/kjo.2010.24.6.377.

Dissociated Horizontal Deviation after Traumatic Brain Injury

• Lee TE
• Cha DS
• Koh SB
• Kim SH

• KMID: 1769095
• DOI: http://doi.org/10.3341/kjo.2010.24.6.377

Abstract

A 4-year-old boy visited the hospital with exotropia after brain hemorrhage caused by trauma. He had undergone decompressive craniectomy and cranioplasty 18 months prior to presentation at our hospital. An alternate prism cover test showed more than 50 prism diopters (PD) of left exotropia when he was fixing with the right eye and 30 PD of right exotropia when he was fixing with the left eye at near and far distance. On the Hirschberg test, 60 PD of left exotropia was noted in the primary position. Brain computerized tomography imaging performed 18 months prior showed hypodense changes in the right middle cerebral artery and anterior cerebral artery territories. Subfalcian herniation was also noted secondary to swelling of the right hemisphere. The patient underwent a left lateral rectus muscle recession of 7.0 mm and a left medial rectus muscle resection of 3.5 mm. Three weeks after the surgery, the Hirschberg test showed orthotropia. On alternate prism cover testing, 8 PD of left exotropia and 8 PD of right esotropia were noted at distance. We report a patient who developed dissociated horizontal deviation after right subfalcian subdural hemorrhage caused by trauma.

Keyword

Brain injuries; Dissociated horizontal deviation; Wounds and injuries

MeSH Terms

Brain Injuries/*complications
Child, Preschool
Decompressive Craniectomy/*adverse effects
Esotropia/*etiology/surgery
Exotropia/*etiology/surgery
Hematoma, Subdural/etiology/radiography/*surgery
Humans
Male
Oculomotor Muscles/*surgery
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 (A) Computerized tomography showed hypodense change at right middle cerebral artery, both anterior cerebral artery territory (black arrow) and subfalcian herniation due to swelling of right hemisphere (white arrow). (B) Diffuse magnetic resonance imaging showed high signal at the right frontoparietooccipital lobe which means decreased diffusion and acute infarction.

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  Fig. 2 Note large temporal deviation of left eyeball about 60 prism diopters (PD) fixing with the right eye (top) and right exotropia of 30 PD fixing with the left eye (middle) preoperatively. A small amount of esodeviation in the right eye and 8 PD of exodeviation in the left eye were noted postoperatively (bottom).

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