4TH NERVE PALSY - HISTORICAL REVIEW AND STUDY OF 215 INPATIENTS

A review of inpatient trochlear nerve pareses diagnosed over 23 years revealed head trauma as the principal cause, with surgical injury, inf lammation, and brain tumors seen occasionally. Ischemic (microvascular ) neuropathies were rare. About one-half of the patients (52%) had no other neuro-ophthalmologic signs, but only 5% were truly isolated, wit hout other neurologic or ophthalmologic signs or symptoms. Fourth nerv e palsies are underdiagnosed on hospital services, where stuporous pat ients encounter unsuspecting physicians.