Post traumatic isolated multiple cranial nerve palsies

A sixty-five years male patient presented in our neurological clinic following a fall from a slope while grazing grass in remote Nepal.He was complaining of drooping of the right eye lid and also having double vision.His Glasgow coma scale (GCS) was 15/15 and his vital parameters were within normal range.Following thorough neurological examination, he was found to have bilateral third (right > left), bilateral fourth (right > left) and partial right sixth nerve palsies along with loss of convergence (Figure 1).Computerized tomogram (CT) head however did not reveal any findings so as to localize the cause for the bilateral ophthalmoplegia.Magnetic resonance imaging (MRI) T2W and the FLAIR (Fluid attenuated inverse recovery) sequences revealed focal contusion in the anterio-lateral aspect of the midbrain along the region of the pyramidal tracts within the crus cerebri on the right side (Figure 2).