Fourth nerve palsy: Difference between revisions
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**Intorts, depresses and abducts the globe | **Intorts, depresses and abducts the globe | ||
*Most common cause of vertical diplopia | *Most common cause of vertical diplopia | ||
* | ===Etiology=== | ||
*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> | |||
*Mechanisms that increase IOP | |||
**Practically never involved by aneurysm | **Practically never involved by aneurysm | ||
*Herpes zoster opthalmicus | *Herpes zoster opthalmicus | ||
* | *Meningitis | ||
* | *Diabetic neuropathy | ||
*Lupus/Sjogren syndrome | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 10:57, 6 September 2015
Background
- Trochlea innervates superior oblique muscle
- Intorts, depresses and abducts the globe
- Most common cause of vertical diplopia
Etiology
- Head trauma [1]
- Mechanisms that increase IOP
- Practically never involved by aneurysm
- Herpes zoster opthalmicus
- Meningitis
- Diabetic neuropathy
- Lupus/Sjogren syndrome
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
Diagnostic Evaluation
- 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
Medscape: Trochlear Nerve Palsy