Trochlear motorneurons were identified by applying horseradish peroxidase(HRP) to superior oblique muscle in cats. Ninety five to ninety seven percent of the contralateral trochlear nucleus were stained 3-5% of ipsilateral side also labelled by HRP. These findings showed that superior oblique muscle was innervated by trochlear nuclei on both side.
Animals ; Armoracia* ; Cats* ; Horseradish Peroxidase* ; Trochlear Nerve

Superior oblique myokymia (SOM) is a rare disorder characterized by unilateral paroxysmal oscillopsia or diplopia. Recent studies revealed that SOM can be associated with neuro-vascular cross compression (NVCC) of the trunk of the trochlear nerve. Although it frequently occurs without any underlying systemic disease or concurrent neurologic sign, we need to consider this NVCC especially in cases with persistent disturbing symptoms. Hereby, we present two cases of SOM whose neuroimaging studies suggest NVCCs and, discuss recent update of the pathomechanism of SOM.
Diplopia ; Nerve Compression Syndromes ; Neuroimaging ; Neurologic Manifestations ; Trochlear Nerve ; Trochlear Nerve Diseases

The most cases with orbital metastases have been reported in patients with a prior established diagnosis of cancer and widespread systemic involvement. However, ocular symptoms can be developed as an initial presentation of cancer in patients without cancer history. We report a case of rapid progression from trochlear nerve palsy to orbital apex syndrome as an initial presentation of advanced gastric cancer.
Diagnosis ; Diplopia ; Humans ; Neoplasm Metastasis ; Optic Nerve Diseases ; Orbit ; Stomach Neoplasms ; Trochlear Nerve Diseases ; Trochlear Nerve

With the increase in human immunodeficiency virus (HIV) infection, the incidence of syphilis also increased worldwide presenting with diverse clinical manifestations. We experienced a case of symptomatic early neurosyphilis manifesting as optic neuritis and trochlear nerve palsy with typical skin lesions of secondary syphilis in an HIV-Infected patient. Intravenous penicillin and oral steroid were administered for 2 weeks. Skin lesions improved after a week, and ocular lesions resolved completely after eight weeks of treatment.
HIV ; Humans ; Incidence ; Male ; Neurosyphilis ; Optic Neuritis ; Penicillins ; Skin ; Syphilis ; Trochlear Nerve ; Trochlear Nerve Diseases

40 patients who were diagnosed as the palsy of the third, fourth and sixth cranial nerve at Seoul national university hospital, were evaluated to reveal the etiology and clinical feature. The palsy of sixth cranial nerve is most common, and those of third and fourth cranial nerve followed it. Trauma was the most common cause of the palsy of the third, fourth, and sixth cranial nerve. Most of the palsy of the third cranial nerve involved both upper and lower branch, and aberrant regeneration was observed at 8 cases and its major cause was also trauma. The palsy of sixth cranial nerve was more frequently accompanied other cranial nerve palsy than those of the other two. Average recovery rate was 44.8% and, that of the sixth cranial nerve was higher than those of the other two.
Abducens Nerve Diseases* ; Abducens Nerve* ; Cranial Nerve Diseases ; Humans ; Oculomotor Nerve ; Paralysis ; Regeneration ; Seoul ; Trochlear Nerve

Superior oblique myokymia is an unusual disorder of ocular motility characterized by rapid, small ampulitude and rotary oscillations limited to one eye. Symptoms of monocular oscillopsia and torsional diplopia are experienced by the patient, and the cause remains obscure. We experienced a case of superior oblique myokymia that developed in a 53-year-old male. We report this unusual case with literature review.
Carbamazepine ; Diplopia ; Humans ; Male ; Middle Aged ; Trochlear Nerve Diseases*

BACKGROUND: Herpes zoster ophthalmicus (HZO) can involve the oculomotor nerve; however, isolated trochlear nerve palsy has rarely been reported. CASE REPORT: An 83-year-old man who suffered from HZO in the right frontal area and scalp subsequently developed vertical diplopia and severe pain. Cerebrospinal fluid examination and brain MRI revealed no abnormalities. Isolated right trochlear nerve palsy was diagnosed based on the findings of neuro-ophthalmological tests. CONCLUSIONS: Isolated trochlear nerve involvement associated with HZO is very rare and may be easily overlooked. Physicians should carefully examine oculomotor involvement in HZO.
Aged, 80 and over ; Brain ; Diplopia ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Scalp ; Trochlear Nerve ; Trochlear Nerve Diseases

A etiologic analysis of 94 cases of the paralysis of the third, fourth, and sixth cranial nerves was made. There were 42 cases(44.7%) of sixth nerve paralysis. 39 cases(41.5%) of third nerve paralysis. 5 cases(5.3%) of fourth nerve paralysis and 8 cases(8.5%) of multiple cranial nerve paralysis. The most common cause was head trauma(46 cases). Other etiologic factors were undetermined(23 cases), neoplasm(5 cases), vascular desease(6 case), aneurysm(5 cases) and others(9 cases). The recovery rates of sixth, third, and fourth cranial nerve paralysis were 52%, 41%, 20%, respectively.
Abducens Nerve ; Cranial Nerves ; Head ; Oculomotor Nerve Diseases ; Paralysis ; Strabismus* ; Trochlear Nerve

Two patients were presented with painful unilateral oculomotor nerve palsy and one of them was combined with trochlear nerve palsy. First case was initially thought to have diabetic opthalmoplegia, and second case was thought to have posterior communicating or distal internal carotid aneurysms. But both had, in fact dural carotid cavernous fistula, draining posteriorly into inferior petrosal sinus. Embolization was done in these two cases, which was followed by clinical improvement in one case.
Aneurysm ; Fistula* ; Humans ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Trochlear Nerve Diseases

In the microsurgical dissection of the lateral wall of the cavernous sinus, interrelationships of its nerves have been studied in 100 Korean adult half heads. And in the serial coronal section of the cavernous sinus in 10 half heads, the structures of the lateral wall have been studied. The relationships of the nerves of the lateral wall were classified to five types according to the course of the trochlear nerve. Each length of the Parkinson's triangle and the angle between trochlear and ophthalmic nerves were measured. There data were compared with those of the other races. The lateral wall of the sinus was composed of two layers. The orientation of the fibers of the deep layer was variable in regions. The oculomotor nerve was enveloped with sheath extended from dura mater and it was connected with deep layer of the lateral wall. The trochlear nerve was enveloped with sheath formed y division of innermost part of the deep layer. The venous sinus was found between the two layers of the lateral wall. The neurosurgical significance of the lateral wall of the sinus was discussed.
Adult ; Cavernous Sinus* ; Continental Population Groups ; Dura Mater ; Head ; Humans ; Oculomotor Nerve ; Ophthalmic Nerve ; Trochlear Nerve