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Case Reports
. 2010 Jan-Feb;58(1):66-7.
doi: 10.4103/0301-4738.58476.

Isolated trochlear nerve palsy with midbrain hemorrhage

S Raghavendra  1 , K Vasudha, S Ravi Shankar
Affiliations
Case Reports

Isolated trochlear nerve palsy with midbrain hemorrhage

S Raghavendra et al. Indian J Ophthalmol. 2010 Jan-Feb.

Abstract

Midbrain hemorrhage causing isolated fourth nerve palsy is extremely rare. Idiopathic, traumatic and congenital abnormalities are the most common causes of fourth nerve palsy. We report acute isolated fourth nerve palsy in an 18-year-old lady due to a midbrain hemorrhage probably due to a midbrain cavernoma. The case highlights the need for neuroimaging in selected cases of isolated trochlear nerve palsy.

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Figures

Figure 1
Figure 1
MRI brain in a patient with isolated acute left trochlear nerve palsy. Axial T1 SE (A), axial T2 FSE (B), Axial T2*GRE (C) and Sagittal T2WI(D) showing a hypointense lesion in the right tectal region at the level of the inferior colliculus with intense blooming on gradient imaging without any flow voids. E, schematic representation of the anatomical structures of the midbrain at the level of the inferior colliculus overlapped on Figure A. Note: Increased hypointensity of a paramagnetic substance such as blood on T2*GRE (gradient) imaging is termed as blooming
See this image and copyright information in PMC

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