Trochlear nerve palsy: clinical features
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Trochlear nerve palsy: clinical features. There is vertical or oblique diplopia. Fully referenced neurology checklist.
Clinical features
- There is vertical or oblique diplopia
- Diplopia is worse on downward and inward gaze
- There is a contralateral head tilt
- There may be trochleodynia: this is pain in the upper medial angle of the orbit
Clinical tests
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Differential diagnosis
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Investigation
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Treatment
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Synonyms
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References
- Gold DR, Shin RK, Galetta S. Pearls and oy-sters: central fourth nerve palsies. Neurology 2012; 79:e193-e196.
- von Noorden GK, Murray E, Wong SY. Superior oblique paralysis. A review of 270 cases. Arch Ophthalmol 1986; 104:1771-1776.
- Lee KJ, Jeong SH, Lee YH, Lee AY, Kim JM, Hwang JM, Kim JS. Fourth nerve palsy presenting with trochleodynia. J Neurol 2013; 260:677-679.
- Suzuki K, Hirata K, Takiguchi Y, Hori K, Aso Y, Inukai T. Pseudofourth nerve palsy as initial and sole presentation in ocular myasthenia. South Med J 2009; 102:669-670.
- Moster ML, Bosley TM, Slavin ML, Rubin SE. Thyroid ophthalmopathy presenting as superior oblique paresis. J Clin Neuroophthalmol 1992; 12:94-97.
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