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Clinical features

Authoring team

The clinical features of a fourth cranial nerve palsy include:

  • diplopia - particularly marked in reading
  • abnormal head posture - head tilted towards the normal side, face rotated towards the normal side, and the chin is depressed. The affected eye is higher than its fellow.
  • positive head tilt test - affected eye moves higher when the head is tilted towards the affected side
  • early secondary contracture of the inferior oblique may occur resulting in greater hypertropia in upward gaze than in downward gaze

Reference

  1. Kung NH, Van Stavern GP. Isolated Ocular Motor Nerve Palsies. Semin Neurol. 2015 Oct;35(5):539-48.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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