Isolated Fourth Nerve Palsy in Nontraumatic Tentorial Hemorrhage

Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
Eyal Walter, Jonathan D Trobe

Abstract

A 46-year-old woman being treated with warfarin for antiphospholipid antibody syndrome experienced a rise in international normalized ratio (INR) to 5.4 and developed sudden headache and diplopia. Neuro-ophthalmologic examination disclosed a right fourth nerve palsy. Noncontrast computed tomography revealed a subdural hematoma layered along the right tentorium cerebelli, directly in the path of the nerve. With normalization of the INR, the palsy markedly improved over subsequent weeks. This is a unique case of a nontraumatic subdural hematoma causing a fourth nerve palsy.

References

Aug 31, 2013·The Journal of Emergency Medicine·Robert A Bruce-BrandAshley R Poynton
Nov 16, 2016·Open Access Emergency Medicine : OAEM·Victoria Cui, Timur Kouliev
Dec 6, 2017·World Neurosurgery·Michael J MulcahyDarweesh Al-Khawaja

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Antiphospholipid Syndrome

Antiphospholipid syndrome or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by the presence of antibodies directed against phospholipids.

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