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Neurology 1999;53:877
© 1999 American Academy of Neurology
Brief Communications

Isolated trochlear nerve palsy in patients with multiple sclerosis

D. M. Jacobson, MD, M. L. Moster, MD, E. R. Eggenberger, DO, S. L. Galetta, MD and G. T. Liu, MD

From the Departments of Neurology and Ophthalmology (Dr. Jacobson), Marshfield Clinic, WI; the Department of Neurosensory Sciences (Dr. Moster), Albert Einstein Medical Center, Philadelphia, PA; the Center for Clinical Neuroscience and Ophthalmology (Dr. Eggenberger), Michigan State University College of Osteopathic Medicine, East Lansing, MI; the Departments of Neurology and Ophthalmology (Dr. Galetta), University of Pennsylvania School of Medicine, Philadelphia, PA; and the Departments of Neurology and Ophthalmology (Dr. Liu), University of Pennsylvania School of Medicine, Philadelphia, PA.

Address correspondence and reprint requests to Dr. Daniel M. Jacobson, Neuro-ophthalmology (4F-2), Marshfield Clinic, 1000 N. Oak Avenue, Marshfield, WI 54449.

The authors describe five patients with trochlear nerve palsy and MS to characterize this rare association. In two patients, trochlear nerve palsy was the initial clinical manifestation of MS. In the other three patients, this sign occurred after previous neurologic events. MRI did not identify a lesion of the fourth nerve nucleus or fascicle. Ophthalmoplegia resolved within 2 months in four of the five patients. A reason this association is rare is that the fascicular course of the trochlear nerve is exposed to little myelin.

Key words: Trochlear nerve palsy—Superior oblique palsy—MS—Diplopia.




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