Working Diagnosis:
Cranial nerve VI/left lateral rectus palsy after a concussion
Treatment:
- Reassurance and avoiding practice until convergence and lateral gaze returned to normal.
- After return of normal convergence and lateral gaze, went through vestibular rehab with her ATC.
Outcome:
- 4 weeks after the concussive blow her convergence returned to normal
- 5 weeks after the concussive blow, she was able to achieve full lateral gaze in the left eye
Return to Activity and follow-up:
- After return of full lateral gaze, she restarted practice including hitting live balls and reported no problems with tracking or reaction time.
- 5.5 weeks after the concussive blow, she played in a collegiate volleyball game without issues. She had good reaction time and did not report any problems with vision or following the ball. She played well and continues to play for the team.
Editor's Comments:
This case illustrates the significant variability in concussion presentation. While she had recovered her symptoms, balance and cognitive function, her visual tracking ability lagged far behind and was a significant disability for several weeks. Clinicians evaluating concussion should remember that presentations can be highly variable and athletes are not appropriate to return to play until all findings are resolved.
References:
Dhaliwal, A., West, A. L., Trobe, J. D., & Musch, D. C. (2006). Third, fourth, and sixth cranial nerve palsies following closed head injury. J Neuro-Ophthalmol, 26; 1: 4-10.
Moster, M. L. et al. (1984). Isolated sixth-nerve palsies in younger adults. Arch Ophthalmol, 109;9:1328-1330.
Return To The Case Studies List.