SeungHa Lee1, Sung-Hee Kim2, Hee Kyung Yang3, Jeong-Min Hwang3, Jae Hyoung Kim4, Ji-Soo Kim2, Seong-Ho Park5. 1. Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. 2. Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea. 3. Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea. 4. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea. 5. Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea. Electronic address: nrpsh@snu.ac.kr.
Abstract
BACKGROUND: Congenital trochlear palsy may manifest with sudden vertical diplopia due to decompensation during the later life, which may bring a diagnostic challenge. CASE PRESENTATION: Two men with vertical diplopia for several years after age of 50 were referred with persisting or suddenly aggravating diplopia. Findings were consistent with unilateral superior oblique palsy (SOP) in both patients with a contraversive head tilt. Facial asymmetry was suggestive of a congenital cause in a patient. High resolution magnetic resonance image (MRI)s disclosed atrophic superior oblique and absent trochlear nerve in the side of SOP in both patients. CONCLUSION: Imaging demonstration of superior oblique atrophy and absent trochlear nerve may aid in diagnosis of congenital SOP presenting sudden vertical diplopia during the later life due to delayed decompensation.
BACKGROUND:Congenital trochlear palsy may manifest with sudden vertical diplopia due to decompensation during the later life, which may bring a diagnostic challenge. CASE PRESENTATION: Two men with vertical diplopia for several years after age of 50 were referred with persisting or suddenly aggravating diplopia. Findings were consistent with unilateral superior oblique palsy (SOP) in both patients with a contraversive head tilt. Facial asymmetry was suggestive of a congenital cause in a patient. High resolution magnetic resonance image (MRI)s disclosed atrophic superior oblique and absent trochlear nerve in the side of SOP in both patients. CONCLUSION: Imaging demonstration of superior oblique atrophy and absent trochlear nerve may aid in diagnosis of congenital SOP presenting sudden vertical diplopia during the later life due to delayed decompensation.