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At least 55 records · Page 3Linked to original sources
PubMed1988

Humeral trochlear hypoplasia secondary to epiphyseal injury as a cause of ulnar nerve palsy.

Humeral trochlear hypoplasia (HTH) is a rare condition that occasionally results in ulnar nerve palsy. A 41-year-old man developed HTH secondary to an epiphyseal injury of the trochlea incurred 33 years earlier. This may be the first report of a case of HTH caused by injury. The ulnar nerve appeared compressed by the malposition of the HTH against the medial head of the triceps brachii when the joint was flexed. The close proximity of the olecranon to the HTH also allowed the triceps brachii muscle to compress the nerve by displacing medially and overriding the bone. The condition was resolved surgically and the patient returned to his former occupation as a coal miner.

Adult↗
PubMed1995

Transient trochlear nerve palsy following anterior temporal lobectomy for epilepsy.

Three of 22 patients (14%) who underwent anterior temporal lobectomy for treatment of medically intractable epilepsy at our institution from July 1987 through July 1993 experienced diplopia immediately after surgery. We found ipsilateral paresis of the superior oblique muscle in all three patients. Their ophthalmoplegia resolved completely within 14 weeks. We did not observe any new structural or ischemic changes on postoperative MRIs to account for their deficits. Trochlear nerve palsy--not oculomotor nerve palsy, as is reported in most reference texts--is a relatively common cause of transient diplopia following temporal lobectomy. Indirect (ie, traction) injury of the trochlear nerve is a plausible mechanism that would explain this complication.

Adult↗
PubMed2001

Localization of post-traumatic trochlear nerve palsy associated with hemorrhage at the subarachnoid space by magnetic resonance imaging.

PURPOSE: To report evaluation of traumatic trochlear nerve palsy using head magnetic resonance imaging. DESIGN: Observational case reports. METHODS: We examined two cases involving trochlear nerve palsy after closed head injury. RESULTS: Using a fluid attenuated inversion recovery pulse sequence, MRI showed a high-intensity lesion consistent with subarachnoid hemorrhage at the trochlear nerve area in the ambient cisterns. CONCLUSION: An impact force directed toward the tentorium can be a mechanism of injury in some post-traumatic trochlear nerve palsies. Fluid attenuated inversion recovery pulse sequence is a sensitive method for detection of abnormalities in cases associated with head injury.

Adolescent↗
PubMed1999

Differential regulation of alpha- and beta-CGRP mRNAs within oculomotor, trochlear, abducens, and trigeminal motoneurons in response to axotomy.

Spinal and cranial motoneurons express alpha- and beta-calcitonin gene-related peptide (CGRP) mRNAs constitutively at variable ratios, and these two mRNAs are differentially regulated following axotomy in spinal, facial, and hypoglossal motoneurons. The purpose of this study was to investigate the change in CGRP mRNA expression following nerve injury in oculomotor, trochlear, abducens, and trigeminal motor nuclei in which beta-CGRP mRNA is predominantly expressed under normal conditions. Using male Sprague-Dawley rats, either the left eyeball and the orbital contents including the bulbar muscles were removed, or the left masseter nerve was ligated and transected. The rats were allowed to survive for 1, 3, 7, 14, 28, 56 days following these procedures. The levels of mRNAs for alpha- and beta-CGRP and growth-associated protein (GAP)-43 were analyzed by in situ hybridization histochemistry using 35S-labeled oligonucleotide probes. Following nerve injury, the expression of alpha-CGRP mRNA rapidly increased on the directly-injured side in all of these nuclei. Thereafter, it gradually decreased and returned to about the control level at postoperative day 56 within oculomotor, trochlear, and abducens motoneurons, but it sustained at a high level within trigeminal motoneurons. The expression of beta-CGRP was quite variable among these nuclei, and significant changes were also seen on the side contralateral to the directly-injured side. These data indicate that the up-regulation of alpha-CGRP mRNA may be a common response of cranial motor neurons following axotomy even if the constitutive expression of beta-CGRP mRNA exceeds that of alpha-CGRP mRNA in these neurons.

Abducens Nerve↗
PubMedDate not supplied

Central trochlear palsy.

Historically, the trochlear (IV) nerve has been "neglected" by neurologists and ophthalmologists. However, the reported incidence of trochlear palsy in two large series has more than doubled in the past two decades, indicating increasing awareness of this nerve. Trauma is the most common cause of trochlear palsy, as the trochlear nerve is anatomically more vulnerable to trauma than the other ocular motor nerves. Trochlear palsy can also be caused by vascular and inflammatory diseases, congenital factors, toxic substances and tumors. Diplopia secondary to vertical and horizontal deviation is the most common presentation. The trochlear nerve has a relatively high recovery rate after the underlying cause of injury has been corrected. In this article, the anatomy and physiology of the trochlear nerve are described, and the various etiologies, methods of diagnosis and differential diagnosis of trochlear palsy are reviewed.

Amblyopia↗
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↗
PubMed1986

Superior oblique myokymia: a prism lens approach to control.

A clinical evaluation of a 35-year-old man with episodic vertical diplopia and oscillopsia is discussed. A diagnosis of superior oblique myokymia, a relatively rare and frequently undiagnosed neuromuscular syndrome is made. Considerable medical research suggests that this is a motor neuron disturbance related to regeneration following injury or inflammation of the trochlear nerve. This report discusses control of one patient's symptoms of monocular image fluttering with prism lenses. Various medical approaches including surgery have been found to have limited success and involve a high risk due to many contraindications.

Adult↗
PubMed1993

Fourth nerve palsy: historical review and study of 215 inpatients.

A review of inpatient trochlear nerve pareses diagnosed over 23 years revealed head trauma as the principal cause, with surgical injury, inflammation, and brain tumors seen occasionally. Ischemic (microvascular) neuropathies were rare. About one-half of the patients (52%) had no other neuro-ophthalmologic signs, but only 5% were truly isolated, without other neurologic or ophthalmologic signs or symptoms. Fourth nerve palsies are underdiagnosed on hospital services, where stuporous patients encounter unsuspecting physicians.

Adolescent↗
PubMed1998

[Changes in subjective cyclodeviation and objective cycloposition after modified Harada-Ito operation in acquired trochlear paralysis].

BACKGROUND: After recently published own investigations on subjective and objective cyclorotatory changes following inferior oblique recession for inferior oblique overaction, it was our aim to determine and to compare subjective and objective cyclorotatory changes following a modified Harada-Ito procedure for acquired trochlear palsy. PATIENTS AND METHODS: Eight patients suffering from acquired uni-(n = 3) or bilateral (n = 5) trochlear palsy were investigated before surgery and 1 day, 3 days and 4 months after surgery. Subjective cyclodeviation was assessed by Harms' tangent scale. Objective cycloposition was measured by means of fundus cyclometry using an infrared Scanning Laser Ophthalmoscope. RESULTS: The immediate postoperative incyclorotatory effect was 12 degrees in the unilateral group and 18 degrees in the bilateral group. Subjective and objective changes were nearly equal in both groups, with a subjective over-effect of 1 degree. After two days of binocular stimulation a marked regression of the surgical effect was found which still increased after four months. The long term incyclorotatory effect was subjectively and objectively nearly equal in the unilateral group which showed a relaps of subjective excyclodeviation of 5 degrees: in the bilateral group, the subjective effect was more pronounced than the objective effect, the immediate postoperative over-effect being disappeared. CONCLUSIONS: In contrast to our results concerning inferior oblique muscle recession for strabismus sursoadductorius, subjective and objective cyclorotatory changes did not differ grossly following a modified Harada-Ito procedure. Subjective and objective short and long term regression was confirmed which objectively exceeded the amount of over-correction. As the underlying cause mechanical and sensory mechanisms are discussed.

Adult↗
PubMed1995

Stereotactic radiosurgery of anterior skull base tumors.

Stereotactic radiosurgery is an increasingly safe and usually effective method of preventing growth of small to moderate-sized primary tumors of the anterior skull base. Tumor growth control is obtained in more than 90% of patients with skull base tumors having benign histology. Neurologic function is maintained in most patients. The risk of temporary or permanent injury to critical neural and vascular structures is significantly lower than the risk associated with microsurgery. The optic nerves, chiasm, and tracts are structures that appear most sensitive to the radiation doses used during radiosurgery of anterior skull base tumors. The incidence of injury to the optic apparatus is low when the dose to the nerve is less than 8 to 9 Gy (27). The incidence of injury to motor nerves, such as the oculomotor, trochlear, trigeminal, and abducens nerves, is extremely low at the doses used in clinical radiosurgery (27). To date no cases of delayed carotid injuries have been reported. Microsurgical complications (e.g., CSF leak, wound infection, and meningitis) do not occur after radiosurgery. Additional attractive features of radiosurgery are a relatively low, hospital-based cost and a rapid return of the patient of work. In the report of our experience with the first 207 patients treated with the Gamma Knife at the University of Pittsburgh, the average length of hospital stay was 2.24 days for a patient undergoing stereotactic radiosurgery for a skull base tumor and 11.44 days for a patient undergoing craniotomy for the same lesion. The total hospital charges were 30 to 70% lower for patients having radiosurgery (19). The average hospital stay and cost of radiosurgery are even lower now, because most radiosurgery patients are released from the hospital on the same day as their procedure. Patients are usually able to return to a full preoperative functional level and employment within 3 to 5 days. There are patients in certain clinical situations in which microsurgery clearly is required. These include patients experiencing rapidly progressive visual deterioration or who have endocrine-active pituitary tumors. A more rapid reduction in endocrine dysfunction is best achieved by microsurgical tumor excision. In patients in whom a tumor recurs despite "gross total removal," and in cases in which tumor is left behind to preserve critical nerve and vessel integrity, stereotactic radiosurgery is a very effective alternative to additional microsurgical operations. Stereotactic radiosurgery may also be the primary treatment of choice in patients who are unable or unwilling to accept the risk:benefit ratio of microsurgery.

Adult↗
PubMed1999

[Eye muscle surgery in persistent bilateral trochlear paralysis and concomitant Brown phenomenon after indirect craniocerebral trauma].

BACKGROUND: Rarely, an additional Brown's syndrome develops spontaneously in cases of posttraumatic bilateral superior oblique palsy. Surgical measures are controversial and problematic. CASE REPORT: We here report on a 40-year-old patient who, 2 years after blunt head trauma, presented with residual bilateral VIth nerve palsy with 12 degrees excyclotropia in downgaze, abnormal head postures of 20 degrees chin down position in binocular viewing and reduced elevation in adduction. His binocular field of gaze ranged from 10 degrees upgaze to 25 degrees upgaze. After thorough discussion of the situation we suggested bilateral superior oblique tucking, depending on interoperative findings. In a forced duction test under general anesthesia both eyes showed restricted elevation in adduction. Both superior oblique tendons seemed stiff. A 2.5-mm tuck (right) and a 3.0-mm tuck (left) of the anterior part of the tendon were performed. After operation the patient showed a central field of binocular fusion ranging from 10 degrees upgaze to 25 degrees downgaze, in right gaze up to 30 degrees and in left gaze unrestricted. Excyclotropia was present only in downgaze and not more than 6 degrees. CONCLUSION: A low-dosage anterior tuck of the superior oblique tendon was successful in eliminating excyclotropia sufficiently and enlarging the binocular field of fusion.

Adult↗
PubMed1992

Acquired oculomotor, trochlear, and abducent cranial nerve palsies in pediatric patients.

Between January 1966 and December 1988, 160 pediatric patients (age range, 0 to 17 years) were seen at the Mayo Clinic with an acquired oculomotor (35 patients), trochlear (19 patients), abducent (88 patients), or multiple (18 patients) cranial nerve palsy. The clinical findings in the 160 pediatric patients were compared with the results obtained in other reviews of cranial nerve palsies in the pediatric age group and with the adult Mayo Clinic patients with acquired cranial nerve palsies. Trauma was the most common reason for an acquired cranial nerve palsy in our pediatric group. The percentage of patients with an acquired cranial nerve palsy resulting from trauma was significantly greater in the pediatric group (42.5%) than in adults (15.4%) (P < .01). The difference between the percentage of adults (15.2%) and pediatric patients (16.9%) with a cranial nerve palsy secondary to a neoplasm was not statistically significant (P = .28).

Abducens Nerve↗
PubMed1988

Trochlear nerve palsy following minor head trauma. A sign of structural disorder.

Trauma-induced superior oblique palsy usually results from contusion or avulsion of the trochlear nerve or from decompensation of a congenital trochlear nerve palsy. Severe craniocerebral trauma is often associated with the former mechanism, whereas more minor closed-head injuries can decompensate a congenital phoria. We report a patient who developed an isolated trochlear nerve palsy following minor head trauma. Investigation revealed an unsuspected tentorial vascular malformation that was compressing the trochlear nerve in its subarachnoid course. In the absence of other features (e.g., documentation of old head tilt, large vertical fusion amplitudes) that support decompensation of a congenital phoria, compressive lesions should be sought in cases of fourth cranial nerve palsies that follow minor head trauma.

Cranial Nerve Diseases↗