Acquired Isolated Unilateral Trochlear Pareses

Trochlear palsies of this sort in most cases must be attributed to a microvascular pathogenesis. This is consistent with their abrupt onset and their associated risk factors, such as diabetes mellitus, age of 50 or more, hypertension, and generalized arteriosclerosis. In most cases, the cause cannot be proven. A general medical exam to look for unsuspected hypertension or threshold diabetic states is indicated. Usually the problem resolves spontaneously within about 3 months. If it does not recover or is joined by additional signs and symptoms, a more thorough investigation is needed, and should include an MRI of the brain and a lumbar puncture.

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