Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity.However, delayed-onset post-traumatic Accent Cabinet bilateral abducens paresis is extremely rare.We present two cases.
The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days.The cause in the former was detected to be chronic subdural hematoma and in the latter is Princess Bride speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves.The delayed onset of bilateral abducens paresis following head injury may vary according to the cause.
There may be another mechanism of injury apart from direct trauma.Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.