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Fourth cranial nerve palsies can affect patients of any age or gender. They can present with vertical diplopia, torsional diplopia, head tilt, and ipsilateral hypertropia. Determining the onset, severity, and chronicity of symptoms can be vital in delineating between the various etiologies of a CN 4 palsy.
Key points about fourth nerve palsy. Fourth nerve palsy means that a certain muscle in your eye is paralyzed. It is caused by disease or injury to the fourth cranial nerve. In children, it is most often present at birth (congenital). In adults, it is most often caused by injury. Many cases of fourth nerve palsy are idiopathic.
The manifestations and diagnosis of fourth nerve palsy, also known as superior oblique paralysis and trochlear nerve palsy, are reviewed here. Palsies of the third and sixth cranial nerves are discussed separately.
The fourth cranial nerve, also known as the trochlear nerve, arises from the midbrain at the level of the inferior colliculus (ventral to the Sylvian aqueduct). This nerve supplies only a single muscle - the superior oblique (SO) muscle.
Fourth cranial nerve palsy impairs the superior oblique muscle, causing paresis of vertical gaze, mainly in adduction. (See also Overview of Neuro-ophthalmologic and Cranial Nerve Disorders .) Fourth cranial (trochlear) nerve palsy is often idiopathic.
Fourth cranial nerve palsy or trochlear nerve palsy, is a condition affecting cranial nerve 4 (IV), [1] the trochlear nerve, which is one of the cranial nerves. It causes weakness or paralysis of the superior oblique muscle that it innervates.
Congenital Fourth Cranial Nerve Palsy Congenital fourth cranial nerve palsy is common and may decompensate at any age. Decompensated congenital fourth nerve palsy presents as intermittent diplopia in a patient with a long-standing head tilt (obvious on old photographs). There is evidence of chronicity as shown by the following: