Trochlear Nerve Diseases (Fourth Nerve Palsy)

Diseases of the fourth cranial (trochlear) nerve or its nucleus in the midbrain. The nerve crosses as it exits the midbrain dorsally and may be injured along its course through the intracranial space, cavernous sinus, superior orbital fissure, or orbit. Clinical manifestations include weakness of the superior oblique muscle which causes vertical DIPLOPIA that is maximal when the affected eye is adducted and directed inferiorly. Head tilt may be seen as a compensatory mechanism for diplopia and rotation of the visual axis. Common etiologies include CRANIOCEREBRAL TRAUMA and INFRATENTORIAL NEOPLASMS.

Also Known As:

Networked: 34 relevant articles (5 outcomes, 0 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Graves Ophthalmopathy
2.	Vestibular Neuronitis (Vestibular Neuritis)
3.	Pathologic Nystagmus
4.	Cogan Syndrome
5.	Congenital Nystagmus

Experts

1.	Straube, Andreas: 2 articles (04/2005 - 02/2005)
2.	Rusu, Mugurel Constantin: 1 article (07/2015)
3.	Pătraşcu, Jenel Marian: 1 article (07/2015)
4.	Vrapciu, Alexandra Diana: 1 article (07/2015)
5.	Scott, Chris: 1 article (08/2014)
6.	Fam, M Delour: 1 article (08/2014)
7.	Kamel, Mahmoud H: 1 article (08/2014)
8.	Forster, Alan: 1 article (08/2014)
9.	Borgman, Christopher J: 1 article (04/2014)
10.	Yoon, Keon Jung: 1 article (04/2013)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Trochlear Nerve Diseases:

1.	gabapentin (Neurontin)FDA LinkGeneric 05/01/2002 - "Gabapentin may be an effective treatment for superior oblique myokymia; a double-blind study seems justified." 03/01/2004 - "Superior oblique myokymia improved with gabapentin." 05/01/2002 - "Superior oblique myokymia completely resolved after starting gabapentin. " 05/01/2002 - "Two adult patients with superior oblique myokymia, refractory to other therapies, were treated with gabapentin orally after informed consent was obtained. " 05/01/2002 - "To investigate therapeutic effects of oral gabapentin therapy on superior oblique myokymia. "
2.	Carbamazepine (Tegretol)FDA LinkGeneric 01/01/1986 - "Lastly, superior oblique myokymia can be treated successfully with carbamazepine, with tight surveillance for possible adverse side effects. " 06/01/1983 - "Superior oblique myokymia is an unusual eye movement phenomenon generally considered to be a uniocular rotary microtremor easily treated with carbamazepine. " 01/01/2007 - "Finally, anticonvulsants like carbamazepine are the drugs of choice for disorders involving a nerve-blood vessel contact that induces symptoms of vestibular paroxysmia or superior oblique myokymia." 02/01/2005 - "Other pharmacological treatment options are baclofen for periodic alternating nystagmus, gabapentin and memantine for acquired pendular nystagmus, and carbamazepine for superior oblique myokymia." 02/01/2005 - "Several case reports have proven the beneficial effect of baclofen on periodic alternating nystagmus, of gabapentin and memantine on acquired pendular nystagmus, and of carbamazepine and gabapentin on superior oblique myokymia. "
3.	Botulinum Toxins (Botulinum Toxin)IBA 02/01/1997 - "Botulinum toxin in fourth nerve palsies." 01/01/1994 - "Botulinum toxin can also be helpful in third and fourth nerve palsy, in Graves' ophthalmopathy, as an adjunct to transposition surgery and in cases of under- or overcorrections after surgery. " 09/26/2000 - "Fourth nerve palsy unmasked by botulinum toxin therapy for cervical torticollis."
4.	Memantine (Namenda)FDA Link 02/01/2008 - "Resolution of superior oblique myokymia with memantine." 02/01/2005 - "Other pharmacological treatment options are baclofen for periodic alternating nystagmus, gabapentin and memantine for acquired pendular nystagmus, and carbamazepine for superior oblique myokymia." 02/01/2005 - "Several case reports have proven the beneficial effect of baclofen on periodic alternating nystagmus, of gabapentin and memantine on acquired pendular nystagmus, and of carbamazepine and gabapentin on superior oblique myokymia. " 03/01/2011 - "Examples of such causal therapy include aminopyridines for downbeat nystagmus and episodic ataxia type 2; carbamazepine for vestibular paroxysmia, paroxsymal dysarthria and ataxia in multiple sclerosis, and superior oblique myokymia; betahistine, dexamethasone, and gentamicin for Menière's disease; gabapentin and memantine for different forms of acquired and congenital nystagmus; corticosteroids for acute vestibular neuritis and Cogan's syndrome; metoprolol and topiramate for vestibular migraine; and selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo. "
5.	Gadolinium DTPA (Magnevist)FDA Link 04/01/2002 - "In 30 subjects (60 nerves) and in one patient with right superior oblique myokymia (SOM), the anatomy of the trochlear nerve was depicted with three-dimensional (3D) Fourier transformation constructive interference in steady state (CISS) magnetic resonance (MR) imaging, whereas the adjacent vessels were detected with 3D time-of-flight (TOF) MR imaging before and after gadopentetate dimeglumine administration. "
6.	Paroxetine (Paxil)FDA LinkGeneric 03/01/2011 - "Examples of such causal therapy include aminopyridines for downbeat nystagmus and episodic ataxia type 2; carbamazepine for vestibular paroxysmia, paroxsymal dysarthria and ataxia in multiple sclerosis, and superior oblique myokymia; betahistine, dexamethasone, and gentamicin for Menière's disease; gabapentin and memantine for different forms of acquired and congenital nystagmus; corticosteroids for acute vestibular neuritis and Cogan's syndrome; metoprolol and topiramate for vestibular migraine; and selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo. "
7.	Serotonin Uptake Inhibitors (Serotonin Reuptake Inhibitors)IBA 03/01/2011 - "Examples of such causal therapy include aminopyridines for downbeat nystagmus and episodic ataxia type 2; carbamazepine for vestibular paroxysmia, paroxsymal dysarthria and ataxia in multiple sclerosis, and superior oblique myokymia; betahistine, dexamethasone, and gentamicin for Menière's disease; gabapentin and memantine for different forms of acquired and congenital nystagmus; corticosteroids for acute vestibular neuritis and Cogan's syndrome; metoprolol and topiramate for vestibular migraine; and selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo. "
8.	Timolol (Blocadren)FDA LinkGeneric 04/01/2014 - "Topical timolol in the treatment of monocular oscillopsia secondary to superior oblique myokymia: a review."
9.	Propranolol (Inderal)FDA LinkGeneric 02/01/1990 - "Propranolol in the treatment of superior oblique myokymia."
10.	Minocycline (Cyclops)FDA LinkGeneric 01/01/1995 - "A 13-year-old white female with a past medical history of facial acne treated with minocycline presented with headaches, normal visual acuity, bilaterally enlarged blind spots on visual field testing due to bilateral disc edema, and a right fourth nerve palsy. "

Therapies and Procedures

1.	Decompression 01/01/2000 - "Remission of superior oblique myokymia after microvascular decompression." 08/01/2014 - "Microvascular decompression may be considered as a definitive and least destructive surgical option for the treatment of medication refractory superior oblique myokymia." 08/01/2014 - "Microvascular decompression for superior oblique myokymia: case report." 09/01/2005 - "Resolution of superior oblique myokymia following microvascular decompression of trochlear nerve." 12/01/1998 - "Microvascular decompression for superior oblique myokymia: first experience. "
2.	Surgical Decompression 01/01/2003 - "This suggests that the neuro-vascular contact is the cause of this superior oblique myokymia and offers the possibility of neuro-surgical decompression if necessary." 07/01/2015 - "The SCA may determine, as an offending vessel, CNIV compression and superior oblique myokymia and thus surgical decompression may be indicated. "
3.	Spinal Anesthesia 03/01/1987 - "Fourth nerve palsy has been rarely seen following lumbar puncture, myelogram, or spinal anesthesia. " 03/01/1987 - "Fourth cranial nerve palsy following spinal anesthesia. " 04/01/1963 - "Trochlear nerve palsy following spinal anesthesia, a case report."
4.	Tenotomy 01/01/1988 - "In patients operated on for superior oblique myokymia with superior oblique tenotomy or tenectomy, symptoms of oscillopsia recur in approximately one-half. "
5.	Anterior Temporal Lobectomy 08/01/1995 - "Transient trochlear nerve palsy following anterior temporal lobectomy for epilepsy."