Cranial Nerves One to Six Case 1

An 87-year-old man presents to the ED following a fall. He tripped on a kerb whilst out shopping and sustained a frontal head injury. He is complaining of pain around his left eye and horizontal diplopia on looking to the left. He has full recollection of events and denies vomiting. There is no other injury.

Past medical history is confined to hypertension. His only medications are simvastatin and aspirin.

On examination he is alert and orientated. His wife, who is with him, confirms there has been no loss of consciousness. He has a left periorbital bruise but no subconjunctival haemorrhage. Visual acuity and pupil response to light and accommodation is normal. There is a convergent squint at rest and the left eye cannot abduct past the midline. Other eye movements are normal.

Which cranial nerve is involved?

As a general testing strategy, which other cranial nerves are tested with the abducens nerve?

Which investigations would you order for this patient?

Select one or more options.

A series of scans were taken and the results are shown below.

Click on the scans to enlarge.

Record your diagnosis and explain what the consequences of this type of injury are for this patient.