AN UNUSUAL CASE OF TROCHLEAR NERVE PALSY

Abstract

Trochlear nerve palsies are commonly encountered condition in neuroophthalmic as well as in general ophthalmic practice. Though adult cases usually  presents with an history of trauma or have an ischaemic cause due to systemic illness and have a relatively benign and mostly self limiting course, it is important to find             conditions which may cause irreversible neurological               sequelae. A 28 year old male presented with complaints of double vision for 4 days with history of headache on and off for 1 month. He had no history of systemic illness or trauma. Ocular examination revealed right fourth nerve palsy. Rest of the neurological and systemic examination were normal. MRI brain showed diffuse thickening of tentorial petroclinoid ligament with tiny excrescences along insertion site suggestive of hypertrophic pachymeningitis. Secondary causes of hypertrophic pachymeningitis were ruled out by serological and immunological tests. He was treated with intravenous methylprednisolone followed by tapering doses of oral prednisolone. A high index of suspicion, prompt diagnosis and early institution of steroid therapy may help to prevent irreversible neurological sequelae.