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

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

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

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

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

There is an increasing number of reports that the lesion site in isolated cranial neuropathies may be the brainstem. The authors describe a diabetic patient with peripheral type facial palsy and concurrent trochlear palsy. Magnetic resonance imaging showed only a small pontine infarction responsible for the facial palsy. Multiple cranial nerve palsies seen in this patient might be a manifestation of multiple acute small infarcts involving both the brainstem and its cranial nerve root simultaneously.
Brain Stem ; Brain Stem Infarctions ; Cranial Nerve Diseases ; Cranial Nerves ; Diabetes Mellitus* ; Facial Paralysis ; Humans ; Infarction ; Magnetic Resonance Imaging ; Paralysis ; Trochlear Nerve Diseases* ; Trochlear Nerve*

PURPOSE: To evaluate the natural course of superior oblique palsy (SOP) with objective criteria, and to show the contemporary etiology and recovery rates among several factors. The clinical features of SOP were compared to previous studies. METHODS: A retrospective chart review of 80 patients diagnosed with SOP between January 1, 2006 and December 31, 2011 was performed. RESULTS: Clinical SOP features showed variation when compared to previous studies. Out of 80 patients, 71 were identified with unilateral isolated and 9 bilateral cases of SOP. Twenty cases were congenital and 60 cases were acquired SOPs. Acquired SOPs were affected most commonly by trauma (31%) and vascular disease (30%). Twenty-four out of 49 patients, who were followed up over 2 months after the first visit recovered, especially vascular origin cases, which was statistically significant (75%, p = 0.000). Patients with initial vertical deviation smaller than 5 Prism diopters (PD) experienced a more successful recovery than patients with an initial deviation larger than 5 PD. CONCLUSIONS: SOP has different recovery rates depending on the etiology. Accurate ocular examination and understanding of SOP etiology are necessary for successful treatment.
Humans ; Natural History ; Paralysis ; Retrospective Studies ; Trochlear Nerve Diseases ; Vascular Diseases