title: Dissociated horizontal deviation after traumatic brain injury.
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.
authors.affiliation: Department of Ophthalmology, Korea University College of Medicine, Ansan, Korea.
authors.forename: Tae-Eun
authors.initials: TE
authors.lastname: Lee
authors.forename: Deok-Sun
authors.initials: DS
authors.lastname: Cha
authors.forename: Seong-Beom
authors.initials: SB
authors.lastname: Koh
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Kim
mesh_terms: D001930:Brain Injuries / Q000150:complications*; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D004948:Esotropia / Q000209:etiology* / Q000601:surgery; D005099:Exotropia / Q000209:etiology* / Q000601:surgery; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome