Trochlear Nerve Palsy Due to Quadrigeminal Plate Cistern Lipoma

Intracranial lipomas are rare, accounting for <0.1% of primary brain lesions. The majority are interhemispheric (45%) followed by a quarter that are quadrigeminal or superior cerebellar (25%). Intracranial lipomas are most often asymptomatic incidental imaging findings. 55% of patients have associated brain malformations as the primary source of neurologic symptoms. Prior case reports and literature reviews have shown that isolated symptomatic quadrigeminal plate cistern lipomas can result in obstructive hydrocephalus, elevated intracranial pressure, and seizures. In this case report, we present a rare clinical presentation for a classically asymptomatic brain lesion.