Isolated central 4th nerve palsy

Update item information
Identifier central_4th_NP
Title Isolated central 4th nerve palsy
Subject Fourth Nerve Palsy, OMS Midbrain
Creator Kemar Green, DO, Department of Neurology, Michigan State University; Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
Description This is a 40-year-old man with a right hypertropia that worsened in left and down gaze in addition to right head tilt, and improved in left head tilt. There was subjective excyclotorsion OD with double Maddox rod testing. This was consistent with a right 4th nerve palsy. He had a known left midbrain cavernoma which had bled several years prior to this evaluation making the localization of his 4th nerve palsy "central". Given the proximity of the left 4th nucleus and its fascicle to the left medial longitudinal fasciculus (MLF) and oculosympathetic tract, when a left internuclear ophthalmoplegia (INO) and/or left Horner's syndrome, respectively, is seen with a right (CONTRALATERAL) 4th nerve palsy, a "central" 4th is strongly suggested relating to the decussating course of the 4th nerve (see However, an isolated 4th nerve palsy can also be central and related to nuclear and/or fascicular injury, as in this case.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2018-02
Format video/mp4
Rights Management Copyright 2018. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s6hf1tbf
Setname ehsl_novel_gold
Date Created 2018-02-07
Date Modified 2018-05-14
ID 1295179
Reference URL
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