Concluded Case

How common is Trochlear nerve palsy

Paresis of right superior oblique muscle, post -infectious cranial neuropathy. Patient presented with diplopia on downward gaze. Earlier, the patient had a viral febrile illness with exenthem about 10 days ago, scrub typhus IgM pos. Pt advised regular review and follow up for next 2 months.

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Diplopia while getting down staircase (looking down)is characteristic of 4th nerve palsy). But isolated 4th cranial nerve palsy is rare. Its an interesting case.The action of the nerve is looking downwards and inwards.

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Trochlear nerve only nerve to exit from brain stem on dorsal side supply a single muscle smallest nerve in terms of axons it contain , presented with diplopia while looking down after viral febrile illness due to scrub typhus infection .patent with one side of palsy will have that side eye higher than other side with tilting head towards the affected eye side in this case is due to viral infection. Most of the time it recovers passage of time otherwise prism lens are advised for correction of diplopia

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Diplopia while getting down staircase (looking down)is characteristic of 4th nerve palsy). But isolated 4th cranial nerve palsy is rare. Its an interesting case.The action of the nerve is looking downwards and inwards.

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thanks for sharing sir

Nice case, what was MR finding ? Is ncs abnormality was there ?

Plan to do MRI and NCS on next visit if there is no significant improvement.
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NOT MUCH COMMON

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