Trauma is the most common cause of an acquired fourth nerve palsy.1-4 Usually the trauma consists of a severe head injury,3 but mild head injury remote from the orbit may also produce a fourth nerve palsy,5 which suggests a predisposing condition such as an intracranial mass.6
The palsy may result from injury in the brain stem affecting the fourth nerve nucleus or fascicle. Damage may also occur in the subarachnoid space, either stretching or compressing the nerve against the tentorium.7 In this report, a mass lesion, a hematoma, probably compressed the fourth nerve near the superior cerebellar cistern.
REPORT OF A CASE
A 59-year-old man, with a medical history of several episodes of bleeding (hemoptysis, melena, epistaxis, and skin hemorrhage) while receiving anticoagulants following mitral valve replacement, slipped and fell in the shower, striking the back of his head on the right side. He neither
Lavin PJM, Troost BT. Traumatic Fourth Nerve Palsy: Clinicoanatomic Correlations With Computed Tomographic Scan. Arch Neurol. 1984;41(6):679–680. doi:10.1001/archneur.1984.04210080091022
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