When is neuroimaging indicated in the workup of trochlear nerve palsy (fourth nerve palsy)?

Updated: Oct 08, 2019
  • Author: Zafar A Sheik, MD, MD; Chief Editor: Andrew G Lee, MD  more...
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The patient’s history should be taken into consideration when considering further workup. Acquired isolated and presumed ischemic or posttraumatic fourth nerve palsy often resolves spontaneously. [19] Neuroimaging should be considered for nonisolated, bilateral, progressive, or unexplained fourth nerve palsies. If observation is elected (eg, ischemic, traumatic, congenital) but the fourth nerve palsy does not resolve, further testing including neuroimaging (eg, MRI/MRA, CT scanning of the head and orbit), along with other laboratory studies, may be indicated.

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