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Isolated IVth (trochlear) nerve palsy due to basilar artery dolichoectasia
1Department of Neuro-Ophthalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland. aki.kawasaki@ophtal.vd.ch
Klinische Monatsblatter Fur Augenheilkunde
|May 18, 2006
Summary
Basilar artery dolichoectasia, a condition causing elongation and tortuosity of the artery, can lead to isolated trochlear nerve palsy. This rare presentation requires consideration in neurological diagnoses due to variable outcomes.
Area of Science:
- Neurology
- Neurovascular diseases
Background:
- Basilar artery dolichoectasia (BAD) can cause cranial neuropathies, most commonly affecting the trigeminal and facial nerves.
- Dysfunction of ocular motor cranial nerves due to BAD is rare.
- Isolated IVth (trochlear) nerve palsy secondary to BAD has not been previously documented.
Observation:
- Two male patients, aged 70 and 59, presented with vertical diplopia due to IVth nerve palsy.
- One patient experienced a gradual, painless onset, while the other had an acute onset with periorbital pain.
- Neuroimaging revealed basilar artery pathological tortuosity and displacement towards the affected trochlear nerve.
Findings:
- One patient's palsy worsened over 3.5 years, culminating in a stroke.
- The second patient's palsy resolved spontaneously, but he later developed other cranial nerve dysfunctions.
Implications:
- Basilar artery dolichoectasia should be included in the differential diagnosis for isolated IVth nerve palsy.
- The clinical course and prognosis of this condition are variable and potentially serious.
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