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NEUROLOGY 1995;45:1465-1468
© 1995 American Academy of Neurology

Transient trochlear nerve palsy following anterior temporal lobectomy for epilepsy

Daniel M. Jacobson, MD, John J. Warner, MD and Kevin H. Ruggles, MD

From the Departments of Neurology and Ophthalmology (Dr. Jacobson) and Radiology (Dr. Warner), and the Marshfield Epilepsy Center, Department of Neurology (Dr. Ruggles), Marshfield Clinic, Marshfield, WI.
Received October 13, 1994. Accepted in final form January 24, 1995.
Address correspondence and reprint requests to Dr. Daniel M. Jacobson, Neuro-ophthalmology (4F), Marshfield Clinic, 1000 N. Oak Avenue, Marshfield, WI 54449.

Three of 22 patients (14%) who underwent anterior temporal lobectomy for treatment of medically intractable epilepsy at our institution from July 1987 through July 1993 experienced diplopia immediately after surgery.We found ipsilateral paresis of the superior oblique muscle in all three patients. Their ophthalmoplegia resolved completely within 14 weeks. We did not observe any new structural or ischemic changes on postoperative MRIs to account for their deficits. Trochlear nerve palsy--not oculomotor nerve palsy, as is reported in most reference texts--is a relatively common cause of transient diplopia following temporal lobectomy. Indirect (ie, traction) injury of the trochlear nerve is a plausible mechanism that would explain this complication.

NEUROLOGY 1995;45: 1465-1468




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