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[Midbrain hemorrhage presenting with trochlear nerve palsy--a case report]

Y Mon1

  • 1Department of Medicine, Ayabe Kyoritu Hospital.

Rinsho Shinkeigaku = Clinical Neurology
|January 1, 1996
PubMed
Summary
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A rare case of isolated trochlear nerve palsy resulted from a small, slow-developing midbrain hemorrhage. This finding highlights a unique stroke presentation without other neurological deficits.

Area of Science:

  • Neurology
  • Neuro-ophthalmology
  • Vascular Neurology

Background:

  • Trochlear nerve palsy typically presents with diplopia and is often associated with other neurological signs.
  • Midbrain lesions can affect cranial nerves, but isolated trochlear nerve palsy from hemorrhage is uncommon.

Observation:

  • A 70-year-old female experienced insidious onset of vertical diplopia.
  • Ocular motility was normal, but diplopia worsened with right head tilt and left downward gaze.
  • CT revealed a small, high-density lesion in the left lower midbrain tectum, likely a calcified vascular anomaly.

Findings:

  • The patient presented with isolated trochlear nerve palsy, a first reported stroke case without additional neurological symptoms or signs.
  • The isolated presentation is attributed to the small size and slow development of the midbrain hematoma.

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Implications:

  • This case expands the spectrum of clinical presentations for midbrain hemorrhage.
  • It underscores the importance of considering vascular etiologies in isolated cranial nerve palsies, even without other neurological deficits.
  • Further research into small, slow-developing vascular lesions affecting specific cranial nerves is warranted.