Superior Oblique Palsy from Fourth Cranial Nerve Neuritis Result from Ethmoidal Sinusitis : A Case Report

Abstract

Superior Oblique Palsy from pathology of trochlear nucleus or trochlear nerve is the most common cause of binocular vertical diplopia. Delays in the diagnosis and treatment leading to poor quality of life and vision. A case report of 43-year-old Thai male with no underlying disease was sent to ophthalmologist. He had binocular vertical diplopia for 2 weeks as well as bad smell symptom for 3 days before he came to hospital. The physical examination found that normal visual acuity right hypertropia and excyclotorsion of right fundus. Moreover magnetic resonance imaging (MRI) showed neuritis of right trochlear nerve and right ethmoid sinusitis. The patient was treated by antibiotic, corticosteroid and nasal spray decongestant. After 2 weeks of treatment, the absence of diplopia and bad smell were presented in patient.