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A review of inpatient trochlear nerve pareses diagnosed over 23 years revealed head trauma as the principal cause,with surgical injury, inflammation,and brain tumors seen occasionally.Ischemic(microvascular) neuropathies were rare.About one-half of the patients(52%)had no other neuro-ophthalmologic signs,but only 5%were truly isolated,without other neurologic or ophthalmologic signs or symptoms.Fourth nerve palsies are underdiagnosed on hospital services,where stuporous patients encounter unsuspecting physicians. |
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