Fourth nerve palsy: Difference between revisions
No edit summary |
Kghaffarian (talk | contribs) (new page) |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Trochlea innervates superior oblique muscle | |||
**Intorts, depresses and abducts the globe | |||
*Most common cause of vertical diplopia | |||
*Vulnerable to head trauma <ref>Disorders of Ocular Movement and Pupillary Function In: Adams and Victor's Principles of Neurology. 10th ed. Accessed on AccessMedicine.com on 8/29/2015. Chapter 14 </ref> | |||
**Practically never involved by aneurysm | |||
*Herpes zoster opthalmicus can affect nerve | |||
*Less commonly affected by diabetic infarction | |||
*Palsies seen in lupus and Sjogren syndrome | |||
**Unknown mechanism | |||
==Clinical Features== | ==Clinical Features== | ||
*Vertical diplopia<ref>Sheik Z. Trochlear Nerve Palsy Treatment and Management on emedicine.medscape.com/article/1200187 Accessed on 8/29/2015</ref> | |||
**Worse on downward gaze and gaze away from affected muscle | |||
*Head-tilt | |||
**Tilt typically away from affected side | |||
**May be easier to evaluate on old photos | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Head trauma (adult)]] | |||
*[[Herpes Zoster Ophthalmicus]] | |||
*[[Lupus]] | |||
*Sjogrens | |||
*[[Stroke (main)]] | |||
==Diagnosis== | ==Diagnosis== | ||
*Rule out acute causes including CVA, trauma, herpes zoster | |||
==Management== | ==Management== | ||
*Address any acute causes | |||
*May require surgical correction | |||
==Disposition== | ==Disposition== | ||
*Determined by etiology and clinical condition | |||
==See Also== | ==See Also== | ||
| Line 22: | Line 41: | ||
==External Links== | ==External Links== | ||
http://emedicine.medscape.com/article/1200187-treatment | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 03:53, 30 August 2015
Background
- Trochlea innervates superior oblique muscle
- Intorts, depresses and abducts the globe
- Most common cause of vertical diplopia
- Vulnerable to head trauma [1]
- Practically never involved by aneurysm
- Herpes zoster opthalmicus can affect nerve
- Less commonly affected by diabetic infarction
- Palsies seen in lupus and Sjogren syndrome
- Unknown mechanism
Clinical Features
- Vertical diplopia[2]
- Worse on downward gaze and gaze away from affected muscle
- Head-tilt
- Tilt typically away from affected side
- May be easier to evaluate on old photos
Differential Diagnosis
Diagnosis
- Rule out acute causes including CVA, trauma, herpes zoster
Management
- Address any acute causes
- May require surgical correction
Disposition
- Determined by etiology and clinical condition
See Also
External Links
http://emedicine.medscape.com/article/1200187-treatment