 |
Case Report
Trochlear nerve palsy with subarachnoid hemorrhage in ambient cistern
1 MD, Director, Department of Neurosurgery, Hokuto Hospital, Obihiro, Hokkaido, Japan
Address correspondence to:
Akira Tempaku
7-5 Inada-cho-kisen, Obihiro, Hokkaido 080-0833,
Japan
Message to Corresponding Author
Article ID: 100078Z09AT2025
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Tempaku A. Trochlear nerve palsy with subarachnoid hemorrhage in ambient cistern. J Case Rep Images Med 2025;11(1):1–4.ABSTRACT
Introduction: Subarachnoid hemorrhage in the perimesencephalic cistern is usually of unknown etiology. It is diagnosed by headache or signs of meningeal irritation, which are rarely accompanied by impaired consciousness or central nervous system disturbances, including cranial nerve palsies. The author reports a case of subarachnoid hemorrhage in the perimesencephalic cistern showing ipsilateral trochlear nerve palsy with sudden onset of headache.
Case Report: A 66-year-old man presented headache with diplopia. Neurological examination, including Bielschowsky head-tilt test revealed left isolated trochlear nerve palsy, without any other central nerve system disorders. Magnetic resonance image revealed subarachnoid hemorrhage at the left ambient cistern. The mass of dense hematoma clot in the ambient cistern brought to ipsilateral trochlear nerve palsy. Neural dysfunction improved with following hematoma disappearance.
Conclusion: It is a rare case of isolated trochlear nerve palsy associated with perimesencephalic subarachnoid hemorrhage.
Keywords: Ambient cistern, Bielschowsky head-tilt test, Subarachnoid hemorrhage, Trochlear nerve palsy
SUPPORTING INFORMATION
Author Contributions
Akira Tempaku - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthor declares no conflict of interest
Copyright© 2025 Akira Tempaku. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
