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  • Lesions of the trochlear nerve (CN IV) | Deranged Physiology
    A central lesion affects the contralateral eye: the trochlear nerve is the only cranial nerve that innervates structures contralateral to its nucleus Causes of bilateral CN IV lesions: Freakishly rare
  • Cranial Nerve 4 Palsy - EyeWiki
    Thus, a trochlear nerve palsy causes an ipsilateral higher eye (i e , hypertropia) and excyclotorsion (the affected eye deviates upward and rotates outward) Patients may report vertical and or torsional diplopia that is usually worse on downgaze and gaze away from the affected side
  • Fourth Cranial Nerve Lesions • LITFL • FFS
    Patient may tilt head away from the lesion (towards the opposite shoulder) in an attempt to maintain binocular vision Eye movement testing (use H pattern): Lateral rectus (CN VI) → horizontal outward movement; Medial rectus (CN III) → horizontal inward movement; When eye is abducted: Elevator → superior rectus (CN III)
  • 3. Common Cranial Nerve Lesions Flashcards - Quizlet
    CN IV lesion eye moves upward, particularly with contralateral gaze and head tilt toward the side of lesion (problems going down stairs, may present with compensatory head tilt in the opposite direction)
  • Diplopia 5 – 4th Nerve Palsy - Stanford University
    A fourth nerve nuclear lesion is often associated with a Horner syndrome because the descending sympathetic pathway is very close to the fourth nerve nucleus (the Horner syndrome is on the side of the nuclear lesion, whereas the superior oblique weakness is contralateral to the nuclear lesion because of the fourth nerve’s decussation after
  • Cranial Nerve IV (Trochlear) Palsy | 7. 2 | Westmead Eye Manual
    Cranial nerve IV palsies are extremely common in examinations Although it is the most common cause of a vertical strabismus, the examiner should remember other causes (e g TED, orbital fractures) and not rush into Parks 3 step test unless the clinical picture is suggestive of CNIV palsy
  • » ii. Trochlear (IV) nerve palsyCanadian Neuro-ophthalmology Group
    A contralateral IV palsy may be associated with an ipsilateral Horner’s syndrome (6, 7), ipsilateral limb ataxia (8), or decreased contralateral body and or face sensation (9) A lesion extending superiorly may cause a subtle ipsilateral relative afferent pupillary defect (10)
  • Cranial nerve palsies of the eye - Critical Care Collaborative
    Need neuroimaging to rule out intracranial lesion; Can discharge with ophthal and or neurology follow-up if no intracranial cause found, BP and BSL under control; Posterior communicating artery aneurysm Acute CN III palsy with ipsilateral pupillary dilatation is a posterior communicating artery aneurysm until proven otherwise
  • The Cranial Neuropathies: Oculomotor, Trochlear and Abducens
    Patients with isolated CN III palsy may experience a range of symptoms Often these patient present with horizontal and vertical diplopia at both distance and near 5 With a complete palsy, cover test typically displays a hyper-deviation that increases in magnitude in upgaze and reverses in downgaze





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