Trochlear Nerve Palsy Caused by Quadrigeminal Cistern Lipoma.

Choi, Nam Hyeon; Kim, Won Jae; Kim, Myung Mi

doi:2018.59.11.1087

J Korean Ophthalmol Soc > Volume 59(11); 2018 > Article

Case Report

Journal of the Korean Ophthalmological Society 2018;59(11):1087-1090.
DOI: https://doi.org/10.3341/jkos.2018.59.11.1087 Published online November 15, 2018.

Trochlear Nerve Palsy Caused by Quadrigeminal Cistern Lipoma.

Nam Hyeon Choi, Won Jae Kim, Myung Mi Kim

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. mmk@med.yu.ac.kr

사구수조지방종에 의한 도르래신경마비 1예

최남현⋅김원제⋅김명미

영남대학교 의과대학 안과학교실

Correspondence: Myung‐Mi Kim, MD, PhD
Email: mmk@med.yu.ac.kr

Received: 5 July 2018 • Revised: 20 August 2018 • Accepted: 18 October 2018

Abstract

PURPOSE
To report a case of trochlear nerve palsy caused by quadrigeminal cistern lipoma located in the dorsal midbrain. CASE SUMMARY: A 65-year-old male visited our clinic for intermittent vertical diplopia over 2-year period. Symptoms of diplopia had worsened over the past two weeks. He had no previous medical history except having had diabetes for 1 month. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Pupillary examination was not remarkable. Extraocular examination showed 4 prism diopters (PD) left hypertropia at distant gaze and 4 PD exotropia at near gaze, with adduction elevation of the left eye. The Bielschowsky head tilt test revealed 6 PD left hypertropia on the left gaze and orthotropia on the right tilt. Fundus examination showed excyclotorsion of the right eye and incyclotorsion of the left eye. Brain magnetic resonance imaging revealed quadrigeminal cistern lipoma. Prism glasses were prescribed to alleviate diplopia, and we followed up the lesions without further treatment. CONCLUSIONS: Trochlear nerve palsy can be caused by quadrigeminal cistern lipoma; however, it is uncommon for this condition to be caused by a compressive lesion. Prompt neuroimaging can be helpful to rule out the causes of this condition in patients with atypical symptoms.

Key Words: Diplopia;Lipoma;Quadrigeminal cistern;Trochlear nerve palsy