Fourth nerve palsy - Revision history

Danbot: Add evidence-based Disposition section

2026-03-22T10:03:20Z

Add evidence-based Disposition section

← Older revision		Revision as of 10:03, 22 March 2026
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	*'''Traumatic''': Observation for improvement over 6-8 weeks. Often resolves spontaneously. If progressing or lack of improvement – neuroimaging with MRI		*'''Traumatic''': Observation for improvement over 6-8 weeks. Often resolves spontaneously. If progressing or lack of improvement – neuroimaging with MRI
	*'''Isolated, idiopathic cases''' very rarely have an underlying etiology after prolonged follow-up, and most resolve spontaneously in weeks to months. If no improvement in 2 months, consider neuroimaging. <ref name="brazis">Brazis, PW. Isolated palsies of cranial nerves III, IV, and VI. Seminars in neurology. 2009 Feb. 29(1):14</ref>		*'''Isolated, idiopathic cases''' very rarely have an underlying etiology after prolonged follow-up, and most resolve spontaneously in weeks to months. If no improvement in 2 months, consider neuroimaging. <ref name="brazis">Brazis, PW. Isolated palsies of cranial nerves III, IV, and VI. Seminars in neurology. 2009 Feb. 29(1):14</ref>

			==Disposition==
			*Admit for:
			**Traumatic fourth nerve palsy with other injuries
			**Associated neurologic deficits suggesting central pathology
			*Discharge with outpatient ophthalmology/neurology follow-up for:
			**Isolated fourth nerve palsy with normal imaging
			**Microvascular fourth nerve palsy in patients with vascular risk factors
			*Provide prism glasses referral if symptomatic diplopia

	==See Also==		==See Also==

Rossdonaldson1 at 16:21, 26 September 2020

2020-09-26T16:21:40Z

← Older revision		Revision as of 16:21, 26 September 2020
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	==Background==		==Background==
	[[File:Capture2.PNG\|thumbnail]]		[[File:Capture2.PNG\|thumbnail\|Right eye]]
	[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]		[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]
	*Also called CN IV or trochlear nerve palsy		*Also called CN IV or trochlear nerve palsy

Rossdonaldson1: /* Background */

2020-09-26T16:11:59Z

Background

← Older revision		Revision as of 16:11, 26 September 2020
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	==Background==		==Background==
	*Also called ~~the 4th cranial nerve (~~CN IV) or trochlear nerve palsy		[[File:Capture2.PNG\|thumbnail]]
			[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]
			*Also called CN IV or trochlear nerve palsy
	*Trochlea innervates superior oblique muscle		*Trochlea innervates superior oblique muscle
	**Intorts, depresses and abducts the globe		**Intorts, depresses and abducts the globe

Rossdonaldson1 at 16:01, 26 September 2020

2020-09-26T16:01:25Z

← Older revision		Revision as of 16:01, 26 September 2020
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	==Background==		==Background==
	*Also called the 4th cranial nerve (CN IV) or [[trochlear nerve palsy]]		*Also called the 4th cranial nerve (CN IV) or trochlear nerve palsy
	*Trochlea innervates superior oblique muscle		*Trochlea innervates superior oblique muscle
	**Intorts, depresses and abducts the globe		**Intorts, depresses and abducts the globe

Rossdonaldson1: Rossdonaldson1 moved page Trochlear nerve palsy to Fourth nerve palsy

2020-09-26T16:01:04Z

Rossdonaldson1 moved page Trochlear nerve palsy to Fourth nerve palsy

← Older revision	Revision as of 16:01, 26 September 2020
(No difference)

Rossdonaldson1: /* Background */

2020-09-26T16:00:49Z

Background

← Older revision		Revision as of 16:00, 26 September 2020
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	==Background==		==Background==
	*Also called the 4th cranial nerve (CN IV)		*Also called the 4th cranial nerve (CN IV) or [[trochlear nerve palsy]]
	*Trochlea innervates superior oblique muscle		*Trochlea innervates superior oblique muscle
	**Intorts, depresses and abducts the globe		**Intorts, depresses and abducts the globe

Rossdonaldson1: /* External Links */

2020-09-26T15:58:59Z

External Links

← Older revision		Revision as of 15:58, 26 September 2020
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	==External Links==		==External Links==
	[http://emedicine.medscape.com/article/1200187-overview Medscape: Trochlear Nerve Palsy]		*[http://emedicine.medscape.com/article/1200187-overview Medscape: Trochlear Nerve Palsy]

	==References==		==References==

ClaireLewis: /* Differential Diagnosis */

2019-10-06T22:02:33Z

Differential Diagnosis

← Older revision		Revision as of 22:02, 6 October 2019
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	*''Infection'': [[Meningitis]], [[herpes zoster]]		*''Infection'': [[Meningitis]], [[herpes zoster]]
	*''Congenital'': Dysgenesis of trochlear nerve nucleus or abnormal peripheral nerve		*''Congenital'': Dysgenesis of trochlear nerve nucleus or abnormal peripheral nerve
	*''Autoimmune'': [[Myasthenia gravis]], [[multiple sclerosis]], [[systemic lupus erythematosus]], [[giant cell arteritis]], [[~~Sjogren’s~~]]		*''Autoimmune'': [[Myasthenia gravis]], [[multiple sclerosis]], [[systemic lupus erythematosus]], [[giant cell arteritis]], [[Sjögren]]
	*''Trauma'': Its long course makes it susceptible to traumatic injury. [[Head trauma (adult)]] is the second most common cause. Is generally severe with loss of consciousness. Consider underlying structural abnormalities if results after minor trauma.		*''Trauma'': Its long course makes it susceptible to traumatic injury. [[Head trauma (adult)]] is the second most common cause. Is generally severe with loss of consciousness. Consider underlying structural abnormalities if results after minor trauma.
	*''Endocrine'': [[Thyroid]] ophthalmopathy <ref name="medscape">Sheik Z. Trochlear Nerve Palsy Treatment and Management on emedicine.medscape.com/article/1200187 Accessed on 8/29/2015</ref> <ref name="brazis">Brazis, PW. Isolated palsies of cranial nerves III, IV, and VI. Seminars in neurology. 2009 Feb. 29(1):14</ref>		*''Endocrine'': [[Thyroid]] ophthalmopathy <ref name="medscape">Sheik Z. Trochlear Nerve Palsy Treatment and Management on emedicine.medscape.com/article/1200187 Accessed on 8/29/2015</ref> <ref name="brazis">Brazis, PW. Isolated palsies of cranial nerves III, IV, and VI. Seminars in neurology. 2009 Feb. 29(1):14</ref>

ClaireLewis at 16:48, 3 October 2019

2019-10-03T16:48:54Z

← Older revision		Revision as of 16:48, 3 October 2019
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	===Labs and Tests===		===Labs and Tests===
	*+/- POC glucose, CBC, and other labs depending on suspected diagnosis		*+/- POC glucose, CBC, and other labs depending on suspected diagnosis
	*+/- LP after negative neuroimaging if suspect subarachnoid hemorrhage or meningitis.		*+/- [[LP]] after negative neuroimaging if suspect [[subarachnoid hemorrhage]] or [[meningitis]].
	===Imaging===		===Imaging===
	*[[Head CT]] if traumatic, suspect stroke, or subarachnoid hemorrhage (rare).		*[[Head CT]] if traumatic, suspect stroke, or subarachnoid hemorrhage (rare).
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	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]
	[[Category:Neurology]]		[[Category:Neurology]]
			[[Category:Symptoms]]

ClaireLewis: /* Imaging */

2019-10-02T01:19:38Z

Imaging

← Older revision		Revision as of 01:19, 2 October 2019
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	===Imaging===		===Imaging===
	*[[Head CT]] if traumatic, suspect stroke, or subarachnoid hemorrhage (rare).		*[[Head CT]] if traumatic, suspect stroke, or subarachnoid hemorrhage (rare).
	*MRI is study of choice, although there no increased yield from MRI vs CT scan. <ref name="medscape">Sheik Z. Trochlear Nerve Palsy Treatment and Management on emedicine.medscape.com/article/1200187 Accessed on 8/29/2015</ref> <ref name="brazis">Brazis, PW. Isolated palsies of cranial nerves III, IV, and VI. Seminars in neurology. 2009 Feb. 29(1):14</ref>		*[[brain MRI\|MRI]] is study of choice, although there no increased yield from MRI vs CT scan. <ref name="medscape">Sheik Z. Trochlear Nerve Palsy Treatment and Management on emedicine.medscape.com/article/1200187 Accessed on 8/29/2015</ref> <ref name="brazis">Brazis, PW. Isolated palsies of cranial nerves III, IV, and VI. Seminars in neurology. 2009 Feb. 29(1):14</ref>

	==Management==		==Management==