A 57-year-old man with herpes zoster oticus developed a delayed fourth nerve palsy followed by transient intermittent sixth nerve weakness. Trochlear nerve lesions occur rarely with zoster, particularly in the absence of zoster ophthalmicus. A knowledge of the wide range of motor manifestations and the chronicity of meningitis with zoster will afford earlier diagnosis without resort to arteriography.
Keane JR. Delayed Trochlear Nerve Palsy in a Case of Zoster Oticus. Arch Ophthalmol. 1975;93(5):382-383. doi:10.1001/archopht.1975.01010020394016