Isolated Fourth Nerve Palsy Due to Midbrain Stroke

2015 ◽  
Vol 4 (2) ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Theocharis Papanikolaou ◽  
Cath Gray ◽  
Bernard Boothman ◽  
Gerald Naylor ◽  
George Mariatos

Miller-Fisher syndrome (MFS) is a rare condition characterized by the classical triad of ophthalmoplegia, ataxia, and areflexia (Fisher, 1956). It is considered a variant of Guillain-Barré syndrome (GBS) with which it may overlap, or it can occur in more limited forms. We report a case of a thirty-five-year-old male who presented with a six-day history of diplopia, following a recent chest infection. On examination, he was found to have bilateral sixth nerve palsy, bilateral fourth nerve palsy, bilateral areflexical mydriasis, ataxia and total absence of reflexes. After excluding other conditions, a diagnosis of Miller-Fisher syndrome was made. The patient was administered intravenous immunoglobulin and made an uneventful recovery.


2019 ◽  
pp. 105-110
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak

Fourth nerve palsy is a common cause of binocular vertical diplopia. However, it can be difficult to diagnose because the clinical signs are often subtle. In this chapter, we begin by reviewing the symptoms of fourth nerve palsy. We next discuss clinical maneuvers for diagnosing fourth nerve palsy, including the Parks-Bielschowsky three-step test. We list the common causes for isolated fourth nerve palsy and review its differential diagnosis, which includes skew deviation and myasthenia gravis. We then discuss the indications for neuroimaging in a patient with fourth nerve palsy. Lastly, we discuss management options for fourth nerve palsy, which include prisms and strabismus surgery.


2016 ◽  
Vol 53 (2) ◽  
pp. 70-74 ◽  
Author(s):  
Harold P. Koller ◽  
Scott E. Olitsky ◽  
Mary O'Hara ◽  
Leonard B. Nelson

2020 ◽  
Vol 21 (4) ◽  
pp. 155-156 ◽  
Author(s):  
Masaki Tago ◽  
Yoshio Hisata ◽  
Risa Hirata ◽  
Mika Sakaguchi ◽  
Naoko E Katsuki ◽  
...  

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