Fourth nerve palsy for PACES

Isolated fourth nerve palsies are rare.  In terms of clinical signs, you may see:

A slight head tilt to compensate for the mild unopposed external rotation of the affected eye.

What causes of a fourth nerve palsy do you know?
  • The fourth cranial nerve has the longest intracranial course of any cranial nerve
  • It is therefore vulnerable to damage in head trauma.
  • A palsy could also be caused by pathology in the cavernous sinus or superior orbital fissure, but isolated 4th nerve palsies are very rare and then to be in combination with other intraocular palsies.
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