Chen Wen-Ching, Li Ying-Sheng, Huang Poyin
School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.
J Int Med Res. 2021 Apr;49(4):3000605211008292. doi: 10.1177/03000605211008292.
Trochlear palsy often results from traumatic, congenital and microvascular disorders. An intra-axial lesion as a cause of trochlear palsy is uncommon. Moreover, it usually accompanies other neurological deficits. Isolated trochlear palsy as the only presentation of brainstem stroke is unexpected. This current case report describes a 74-year-old male that presented with trochlear palsy without other neurological signs. Brain magnetic resonance imaging (MRI) revealed an acute midbrain infarction. The case report also reviews recent literature and provides a stepwise algorithm for clinicians to approach patients with trochlear palsy. Despite its rarity, clinicians are advised to consider ischaemic stroke as a cause of trochlear palsy even without other neurological deficits. Early MRI should be performed for prompt and proper management.
滑车神经麻痹常由创伤、先天性和微血管疾病引起。轴内病变作为滑车神经麻痹的病因并不常见。此外，它通常伴有其他神经功能缺损。孤立性滑车神经麻痹作为脑干卒中的唯一表现是出乎意料的。本病例报告描述了一名74岁男性，表现为滑车神经麻痹但无其他神经体征。脑部磁共振成像（MRI）显示急性中脑梗死。该病例报告还回顾了近期文献，并为临床医生提供了一个逐步的算法，以处理滑车神经麻痹患者。尽管其罕见，但建议临床医生即使在没有其他神经功能缺损的情况下，也应将缺血性卒中视为滑车神经麻痹的一个病因。应尽早进行MRI检查，以便及时妥善处理。
