Bilateral trochlear nerve palsies from a brainstem hematoma.

We present a case of bilateral superior oblique palsies after a spontaneous brainstem hematoma. A computerized tomographic scan of the brain revealed a high-density mass lesion consistent with bleeding in the area caudal to the inferior colliculi, where the trochlear nerves decussate and exit the dorsal brainstem. Subsequent studies showed resolution of the density and persistent failure to enhance. Bilateral trochlear nerve palsies due to the nontraumatic brainstem bleeding are extremely rare.