Isolated Oculomotor (Third) Nerve Palsy: A Rare Presentation in a Patient with Bilateral Chronic Subdural Hematoma (CSDH)

Introduction: Incidence of bilateral chronic subdural hematomas (CSDH) is less than unilateral CSDH. Conversion of unilateral to bilateral hematomas after surgery is also less commonly seen. Isolated oculomotor (third) nerve palsy in a case of recurrent bilateral CSDH is a rare entity. Case report: We are presenting a case of isolated third nerve palsy in a patient who has been operated for right sided CSDH about three weeks back.  He presented with blurring of vision, ptosis and dilated pupil of right eye and when CT scan head followed by MRI brain was done it revealed recurrent bilateral CSDH. Intervention: Patient was immediately taken up for the burr hole drainage of bilateral CSDH and patient’s neurological deficits improved in post operative period. Conclusion: Isolated third nerve palsy is rarely seen in a patient with bilateral chronic subdural hematomas (CSDH). Immediate surgery is associated with good neurological outcome.