Delayed Trochlear Nerve Palsy Following Traumatic Subarachnoid Hemorrhage: Usefulness of High-Resolution Three Dimensional Magnetic Resonance Imaging and Unusual Course of the Nerve.
10.13004/kjnt.2018.14.2.129
- Author:
Young San KO
1
;
Hee Jin YANG
;
Young Je SON
;
Sung Bae PARK
;
Sang Hyung LEE
;
Yeong Seob CHUNG
Author Information
1. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
Imaging, three-dimensional;
Magnetic resonance imaging;
Subarachnoid hemorrhage, traumatic;
Trochlear nerve diseases
- MeSH:
Brain;
Brain Stem;
Cranial Nerve Diseases;
Craniocerebral Trauma;
Diplopia;
Emergency Service, Hospital;
Female;
Follow-Up Studies;
Humans;
Imaging, Three-Dimensional;
Magnetic Resonance Imaging*;
Middle Aged;
Neurologic Examination;
Neurologic Manifestations;
Posterior Cerebral Artery;
Subarachnoid Hemorrhage, Traumatic*;
Trochlear Nerve Diseases*;
Trochlear Nerve*
- From:Korean Journal of Neurotrauma
2018;14(2):129-133
- CountryRepublic of Korea
- Language:English
-
Abstract:
Cranial nerve palsies are relatively common after trauma, but trochlear nerve palsy is relatively uncommon. Although traumatic trochlear nerve palsy is easy to diagnose clinically because of extraocular movement disturbances, radiologic evaluations of this condition are difficult to perform because of the nerve's small size. Here, we report the case of a patient with delayed traumatic trochlear nerve palsy associated with a traumatic subarachnoid hemorrhage (SAH) and the related radiological findings, as obtained with high-resolution three-dimensional (3D) magnetic resonance imaging (MRI). A 63-year-old woman was brought to the emergency room after a minor head trauma. Neurologic examinations did not reveal any focal neurologic deficits. Brain computed tomography showed a traumatic SAH at the left ambient cistern. The patient complained of vertical diplopia at 3 days post-trauma. Ophthalmologic evaluations revealed trochlear nerve palsy on the left side. High-resolution 3D MRI, performed 20 days post-trauma, revealed continuity of the trochlear nerve and its abutted course by the posterior cerebral artery branch at the brain stem. Chemical irritation due to the SAH and the abutting nerve course were considered causative factors. The trochlear nerve palsy completely resolved during follow-up. This case shows the usefulness of high-resolution 3D MRI for evaluating trochlear nerve palsy.
