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At least 55 records · Page 3Linked to original sources
PubMed1998

Bilateral trochlear nerve palsy with arachnoid cyst of the quadrigeminal cistern.

PURPOSE: To report bilateral trochlear nerve palsy and its magnetic resonance imaging characteristics in a patient with an arachnoid cyst of the quadrigeminal cistern. METHOD: We performed magnetic resonance imaging of the brainstem of a 54-year-old man who had bilateral trochlear nerve palsy and mild truncal ataxia. RESULTS: Magnetic resonance imaging disclosed an arachnoid cyst of the quadrigeminal cistern with enlargement of the lateral, third, and fourth ventricles. The tectum of the midbrain and the ambient and interpeduncular cisterns were markedly compressed by the arachnoid cyst. CONCLUSION: These findings suggest that the bilateral trochlear nerve palsy in this patient was caused by the arachnoid cyst of the quadrigeminal cistern.

Arachnoid Cysts↗
PubMed1992

Cryptic angioma in the trochlear nerve. Excision of the invaded portion and successful repair with an autologous graft: case report.

Cryptic angiomas, which are intrinsic to cranial nerves, are uncommon. Such lesions involving the trochlear nerve have not been previously described. The authors have therefore found it interesting to report a case fortuitously discovered in a patient with trigeminal neuralgia who underwent a fifth nerve microvascular decompression through the supracerebellar space. The angioma was not responsible for the neuralgia, but because of its potential risk of bleeding, the lesion was treated by resection of the trochlear nerve in its invaded portion. Then, the nerve was successfully repaired with an autograft harvested from the distal part of the sural nerve.

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PubMed2002

Presigmoid transpetrosal approach for the treatment of a large trochlear nerve schwannoma--case report.

A 61-year-old man presented with a rare, large trochlear nerve schwannoma manifesting as left-sided weakness and hypesthesia, bilateral bulbar pareses, and trochlear nerve paresis persisting for 3 months. T1-weighted magnetic resonance imaging with gadolinium revealed an intensely enhanced, well-circumscribed lesion with multicystic formation occupying the prepontine and interpeduncular cisterns and compressing the pons and midbrain with greater extension to the right. The mass was completely removed through the presigmoid transpetrosal approach with preservation of the posterior cerebral, superior cerebellar, and basilar arteries and their branches. Neuroradiological examination after 3 years demonstrated no recurrence. Enlargement of a tumor in the cisternal portion is inclined to involve and/or encase the adjacent major arteries and their branches. The presigmoid transpetrosal approach is one of the best surgical routes to remove a large trochlear nerve schwannoma safely and completely.

Cerebellar Ataxia↗
PubMed1994

Trochlear nerve neurinoma associated with a giant thrombosed dissecting aneurysm of the contralateral vertebral artery.

The authors encountered the unusual case of a 57-year-old man with a right trochlear nerve neurinoma associated with a giant thrombosed dissecting aneurysm of the left vertebral artery. The right trochlear nerve neurinoma was subtotally removed via the right subtemporal transtentorial route. The trochlear nerve entered the tumor directly posterolaterally. The left vertebral artery was clipped just proximal to the thrombosed dissecting aneurysm via the left lateral suboccipital approach. The patient was discharged without neurologic deficits except for the right trochlear nerve palsy. To our knowledge, this seems to be the first reported case of such an occurrence.

Aortic Dissection↗
PubMedDate not supplied

MR imaging of primary trochlear nerve neoplasms.

We present the clinical, anatomic, and MR imaging findings in six patients with seven primary trochlear nerve neoplasms, as well as the MR and clinical criteria that serve to establish the diagnosis of these rare cranial nerve neoplasms. Three patients had a history of neurofibromatosis and five patients had clinical evidence of a trochlear nerve palsy. Six of seven neoplasms produced localized, fusiform enlargement of the proximal cisternal segments of the trochlear nerves. The lesions that were visible on noncontrast MR scans (T1-, T2-, and proton density-weighted) had signal intensities that were virtually identical to normal brain parenchyma. All lesions showed intense, homogeneous enhancement on contrast-enhanced scans. Contrast-enhanced imaging was necessary for the detection of five of seven lesions and greatly increased the value of the MR study in all six patients.

Adult↗
PubMed2000

Traumatic trochlear nerve palsy following minor occipital impact--four case reports.

Four patients presented with transient trochlear nerve palsy following occipital impact. The impact was slight in all patients, and neuroimaging found no lesions of the nerve. Three patients had delayed onset. Two patients did not complain of diplopia, but were only aware of blurred vision. In such patients, the head tilting test was useful for diagnosis. Minor occipital impact can cause trochlear nerve palsy, which requires careful neurological examinations to identify.

Adult↗
PubMed1978

Isolated trochlear nerve palsies in herpes zoster ophthalmicus.

The clinical course of six patients with isolated trochlear nerve palsy as the only ocular motor manifestation of herpes zoster ophthalmicus has been analyzed. Spontaneous recovery occurred in only three. Review of the literature does not clarify the mechanism of such palsies, which potentially may result from the following conditions: local orbital muscle inflammation and ischemia; contiguous intracavernous spread of inflammation from the trigeminal nerve; and a concurrent but independent motor neuropathy or ganglionitis.

Adrenal Cortex Hormones↗
PubMed2002

Branching patterns of rabbit oculomotor and trochlear nerves demonstrated by Sihler's stain technique.

A modified Sihler's stain technique was used to visualize the branching patterns of oculomotor and trochlear nerves. The levator palpebrae, superior rectus, inferior rectus, medial rectus, inferior oblique, superior oblique and tensor trochlea muscles were isolated from the eyes of normal rabbits and processed using modified Sihler's technique. The distributions and terminal ramifications of the oculomotor and trochlear nerves were observed. Two distinct divisions and terminal branches of the oculomotor nerve were shown in detail together with the trochlear nerve distribution. The application of Sihler's technique enables researchers to trace nerve branching within relatively transparent muscles, whereas the nerve fibers are counterstained and clearly visible. This technique could be useful for detailed studies of the motor control of extraocular muscles.

Animals↗
PubMed2004

Trochlear nerve palsy after repeated percutaneous balloon compression for recurrent trigeminal neuralgia: case report and pathogenic considerations.

OBJECTIVE AND IMPORTANCE: Repeated percutaneous balloon compression for the treatment of idiopathic trigeminal neuralgia is infrequent. When a second procedure is performed, the outcome is unknown. A patient developed an isolated trochlear nerve palsy after undergoing percutaneous trigeminal ganglion balloon compression for a second time. The mechanism of diplopia and the complications associated with this technique were studied. CLINICAL PRESENTATION: The patient was a 67-year-old woman with a history of medically refractory idiopathic trigeminal neuralgia involving all three divisions of the right trigeminal nerve. INTERVENTION: Percutaneous balloon compression was performed. Despite initial total relief from pain without complications, the patient again displayed manifestations of trigeminal neuralgia 3 months after the procedure. The pain disappeared after she underwent a second balloon compression procedure, but she developed an isolated trochlear nerve palsy, which spontaneously resolved in 2 months. CONCLUSION: Isolated trochlear nerve palsy is a rare and reversible complication after percutaneous balloon compression for trigeminal neuralgia. This case illustrates that the mechanism of injury to the fourth nerve is the result of an erroneous technique: excessive penetration of the Fogarty catheter in Meckel's cave beyond the porus trigemini and compression of the cisternal segment of the trochlear nerve when the inflated balloon is pushed against the tentorium.

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PubMed2004

[Spontaneous intracranial hypotension associated with trochlear nerve palsy and bilateral chronic subdural hematoma].

Spontaneous intracranial hypotension (SIH) is a rare disease which is associated with variety of symptoms and signs including cranial neuropathies. Though diplopia occurred reportedly in about one fourth of SIH cases, trochlear nerve palsy has been reported only one case in the literature. A 71-year-old previously healthy male developed postural headache and nausea. After 15 days, he began to have diplopia caused by right trochlear nerve palsy. He consulted our hospital 2 months later because only diplopia was not recovered. Magnetic resonance imaging (MRI) showed bilateral thin chronic subdural hematoma (CSDH), brain sagging and downward brain stem displacement, but not ischemic change in brain stem. We suspected SIH for right trochlear nerve palsy, and he had symptomatic therapy. Two months later, he had burr hole surgery because of disturbance of consciousness and right hemiparesis due to progressive bilateral-CSDH. To say nothing of disturbance of consciousness and right hemiparesis, his trochlear nerve palsy was completely recovered after surgery at once. Follow-up MRI showed brain sagging and downward brain stem displacement were recovered.

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PubMed1993

[Isolated trochlear nerve palsy caused by mixed dural-pial arteriovenous malformation of the anterior cranial fossa: a case report].

A 62-year-old male was admitted to our hospital in May, 1985, with double vision, which had persisted for 1 month. The neurological examination revealed left trochlear nerve palsy. A cerebral angiogram showed an arteriovenous malformation at the anterior cranial fossa. The malformation was mainly fed by the left anterior ethmoidal artery which branched off from the orbital branch of the left middle meningeal artery. There was a marked enlargement of anastomosis between the orbital branch of the middle meningeal artery and the recurrent meningeal branch of the lacrimal artery. Bilateral distal branches of the internal maxillary arteries, bilateral anterior falx arteries and the left fronto-orbital artery were also involved in supplying the AVM. The dilated fronto-orbital vein was the main drainer which emptied into the pterygoid plexus via the uncal vein and the sphenoparietal vein. In June 1985, the nidus involving the dura at the region of the cribriform plate and olfactory bulb was totally removed through a left frontal craniotomy. Postoperatively, the isolated left trochlear nerve palsy improved completely within a few days. This is the first reported case of isolated trochlear nerve palsy caused by a mixed dural-pial arteriovenous malformation of the anterior cranial fossa. We concluded that the etiology of isolated trochlear nerve palsy consisted of nerve compression due to the dilated orbital branch of the middle meningeal artery within the superior orbital fissure.

Carotid Arteries↗
PubMed2003

[A case of solitary and unilateral trochlear nerve palsy due to a blunt head impact].

A case of solitary and unilateral trochlear nerve palsy following a minor, blunt head impact is reported. A 72-year-old man fell down backwards from the top of a staircase having 13 steps and hit his right parietal head and shoulder. Routine neurological examination revealed no remarkable findings, however, the subject complained of double vision when he focused downwards. The computed tomography four hours after the initial impact showed a localized small high-density lesion on the left quadrigminal cistern. The magnetic resonance imaging also indicated subarachnoid bleeding expressed by the low-intensity area in T2 weighted images in the same place. There was no evidence of any contusion within the midbrain. Hess chart test clearly showed solitary left superior oblique muscle palsy. The manner of the injury was thought to be quite typical, since he had hit his right parietal area up-side-down when falling, that is, the accelerated force acted as an impact against the firm floor. This impact caused the midbrain concussion against the cerebellar tentorial notch resulting in a localized subarachnoid hemorrhage which caused the unilateral trochlear nerve palsy.

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PubMed1994

Trochlear nerve schwannomas: a case report and literature review.

Trochlear nerve sheath tumours are extremely uncommon, only six cases diagnosed during life having been presented previously. In none of these earlier cases were magnetic resonance imaging studies obtained. We report here upon the clinical presentation, surgical management and post-operative course of a case where the diagnosis was suspected pre-operatively from MRI studies. The radiological appearances are described, together with a review of all previously published accounts of this rare tumour.

Adult↗
PubMed1982

Isolated trochlear nerve palsy secondary to a juvenile pilocytic astrocytoma.

A 9-year-old female developed a fourth nerve palsy which was the first sign of a posterior fossa astrocytoma. The fourth nerve palsy was believed to have resulted from direct invasion of the trochlear nerve rather than compression by hydrocephalus. Sagittal reconstruction of a computed tomogram revealed extension of the tumor into the dorsal midbrain where the trochlear nerve exits.

Astrocytoma↗
PubMed1996

The neurovascular relationships and the blood supply of the trochlear nerve: surgical anatomy of its cisternal segment.

We examined in detail the cisternal segments of 15 trochlear nerves in brain stems injected with India ink and fixed in formalin. The nerves were found to emerge as singular trunks (33.3%), singular trunks with accessory rootlets (13.3%), or two or three roots with (26.7%) or without accessory rootlets (26.7%). The nerves were in close relationship or in contact with the superior cerebellar artery, that is, with the main trunk of the superior cerebellar artery, its medial and lateral terminal stems, the accessory superior cerebellar artery, and the vermian, paravermian, collicular, and lateral hemispheric arteries as well as their small branches. Some of these vessels were connected by anastomoses in 86.7% of the cases. The anastomotic channels varied from 40 to 530 microns in diameter. The cisternal segment of each trochlear nerve was usually supplied by a single long artery, which most often arose from the vermian artery (26.7%) or the collicular artery (26.7%). The feeding vessel ranged from 30 to 80 microns in caliber. We discuss the possible clinical significance of the anatomic data observed in the present study.

Arteries↗
PubMed2006

Isolated IVth (trochlear) nerve palsy due to basilar artery dolichoectasia.

BACKGROUND: Dolichoectasia (elongation, dilatation and tortuosity) of the basilar artery can cause an isolated cranial neuropathy. The trigeminal nerve and facial nerve are most frequently affected. Dysfunction of one of the ocular motor cranial nerves due to basilar artery dolichoectasia is uncommon, and an isolated IVth (trochlear) nerve palsy has not been previously described in the literature. HISTORY AND SIGNS: Two men, ages 70 and 59 years, respectively, presented with vertical diplopia due to a IVth nerve palsy. In one patient, the onset of the IVth nerve palsy was painless and gradual and in the other patient, the onset was acute and associated with periorbital pain. Neuroimaging in both patients revealed pathological tortuosity of the basilar artery around the midbrain and displacement of the artery toward the side of the affected trochlear nerve. THERAPY AND OUTCOME: The patients were observed clinically. One patient had gradual worsening of his palsy for three and one-half years then suffered a stroke. The second patient whose IVth nerve palsy had an acute onset experienced spontaneous resolution of his palsy but later developed dysfunction of other cranial nerves. CONCLUSIONS: Basilar artery dolichoectasia should be considered in the differential diagnosis of an isolated IVth nerve palsy. The clinical course may be variable, and the prognosis is not always benign.

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