Guy J R, Friedman W F, Mickle J P
Department of Ophthalmology, University of Florida, College of Medicine, Gainesville 32610.
J Clin Neuroophthalmol. 1989 Jun;9(2):105-11.
Three patients with nonneoplastic hydrocephalus had bilateral paresis of the trochlear nerves. Associated signs, including paresis of upgaze, light-near dissociation of the pupils, and convergence-retraction nystagmus, suggested rostral involvement of the mesencephalon. Trochlear nerve paresis and accompanying signs improved after revision of ventricular shunts in two patients. Bilateral trochlear nerve paresis may be a localizing sign of involvement of the superior medullary velum (the anatomic site of trochlear nerve decussation) by a dilated sylvian aqueduct and/or downward pressure from an enlarged III ventricle.
三名非肿瘤性脑积水患者出现双侧滑车神经麻痹。相关体征，包括上视麻痹、瞳孔光近反射分离以及集合-退缩性眼球震颤，提示中脑上部受累。两名患者在脑室分流术修复后，滑车神经麻痹及伴随体征有所改善。双侧滑车神经麻痹可能是由于扩张的中脑导水管和/或扩大的第三脑室向下压迫，导致上髓帆（滑车神经交叉的解剖部位）受累的定位体征。
