Abstract

16 yrs old girl presented with complaint of frequent headache for 3 months.CT showed Acute on Chronic Sub dural haemorrhage(SDH) in Right fronto parietal region.Patient underwent emergency decompressive craniotomy. Detailed evaluation was done to find the cause of intracranial bleed.Haematological evaluation showed evidence of haemolytic anaemia with findings correlating with Evans syndrome.On post op day 1, she developed ptosis in RE along with diplopia. Ocular examination: VA of 6/6 in BE with restricted Adduction and Depression in RE with moderate ptosis. Pupil fixed and dilated, not reacting to light in RE. Posterior segment was normal. On Post op MRI imaging, signs of sub dural hematoma was noted in falx cerebri along tentorium cerebelli. All these findings were conclusive of pupil involving 3rd nerve palsy due to compressive lesion(Hematoma). RE patching was done to avoid diplopia. By the end of 6 months, the SDH and 3rd CN palsy had completely resolved.