Background Middle meningeal artery embolisation (MMAE) has recently been proposed as a treatment for subdural haemorrhage (SDH). MMAE aims to decrease the vascular supply to abnormal membranes produced in response to dural space inflammation in SDH.

Methods/Results We report a case of bilateral abducens nerve palsies following bilateral MMAE. A 37-year-old male with Type 1 diabetes, previous traumatic brain injury, and excessive alcohol intake presented with increasing headaches and falls. Brain imaging revealed bilateral SDH with minimal midline shift to the right (2-3mm). He subsequently underwent bilateral MMAE. Immediately post operatively, he noted new binocular horizontal diplopia, with bilateral abducens nerve palsies clinically. Repeat brain imaging revealed stable SDH with new punctate foci of diffusion restriction bilaterally – though none that would explain his abducens nerve palsies. There were no brainstem infarctions and there was no midline shift. 2 month post-operative review showed significant improvement in his bilateral abducens nerve palsies.

Conclusions The vascular supply to the abducens nerve is rich, with multiple external carotid artery and internal carotid artery branches, therefore abducens nerve ischemia is rare. Previous studies with provocative lidocaine testing into the middle meningeal artery for other endovascular procedures showed 3 patients developed transient abducens nerve palsy. There are only two cases of transient diplopia within the MMAE related literature, and it is unclear whether these were CN VI palsies. To our knowledge this is the first reported case of bilateral abducens nerve palsies post MMAE, possibly from indirect ischemia post embolisation of the middle meningeal artery.