A Case of Bilateral Trochlear Nerve Palsy Following Cisternography.

Kim, Keun Hae; Yoon, Sook Hyun; Kim, Sook Young

doi:2014.55.1.155

J Korean Ophthalmol Soc > Volume 55(1); 2014 > Article

Case Report

Journal of the Korean Ophthalmological Society 2014;55(1):155-160.
DOI: https://doi.org/10.3341/jkos.2014.55.1.155 Published online January 15, 2014.

A Case of Bilateral Trochlear Nerve Palsy Following Cisternography.

Keun Hae Kim, Sook Hyun Yoon, Sook Young Kim

Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea. kimsy@cu.ac.kr

뇌조조영술 후 발생한 양측 활차신경마비 1예

김근해⋅윤숙현⋅김숙영

Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea

Abstract

PURPOSE
To report a case of bilateral trochlear nerve palsy following cisternography. CASE SUMMARY: A 43-year-old male with intermittent watery rhinorrhea persisting for 3 months visited the neurosurgery department of our institute. His past medical history included removal of a pituitary adenoma 22 years prior to presentation. Cerebrospinal fluid leakage was suspected and cisternography was performed. The patient was referred to our ophthalmology department for diplopia 3 days after the cisternography. An alternate prism cover test showed 5 prism diopter (PD) right hypertrophia in the primary position, and underaction of bilateral superior oblique muscles and overaction of the left inferior oblique muscle. A positive Bielschowsky test with the head tilted to either side was observed and excyclotorsion was 9degrees on the double Maddox rod test. The patient was diagnosed with bilateral trochlear nerve palsy. After 2 years of follow-up, diplopia persisted and recession of the bilateral inferior oblique muscles was performed. After the surgery, diplopia disappeared, the fundus photography showed no excyclotorsion, and the double Maddox rod test indicated 3degrees of excyclotorsion. CONCLUSIONS: Cisternography should be carefully performed due to the possibility of bilateral trochlear nerve palsy, an extremely rare but possible occurrence following the procedure.

Key Words: Cisternography;Lumbar puncture;Trochlear nerve palsy