Thetrochlearnerveis unique among the cranial nerves in several respects.
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This is due to impairment in the superior oblique muscle innervated by thetrochlearnerve.
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More rarely, the oculomotor nerve andtrochlearnerve(third and fourth nerve palsy, respectively) are affected; both play a role in eye movements.
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By 1998, there had been only one reported case of compression of thetrochlearnerveby vessels.
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Thetrochlearnervesupplies the superior oblique muscle, and when this muscle is non-functional (as in trochlear palsy) the eye "excyclotorts"; i.e. twists/rotates outward.
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The oculomotor nerve comes out between the peduncles, and thetrochlearnerveis visible wrapping around the outside of the peduncles.
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Other names for fourth nerve palsy include superior oblique palsy andtrochlearnervepalsy.
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On either side of this band thetrochlearnerveemerges, and passes forward on the lateral aspect of the cerebral peduncle to reach the base of the brain.
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The eye will be displaced downward, because the superior oblique (innervated by the fourth cranial ortrochlearnerve), is unantagonized by the paralyzed superior rectus, inferior rectus and inferior oblique.
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Damages to these structures produce the ipsilateral presentation of paralysis or palsy due to the lack of cranial nerve decussation (aside from thetrochlearnerve) before innervating their target muscles.
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Superior oblique myokymia is an uncommon neurological condition caused by vascular compression of thetrochlearnerveresulting in repeated, brief, involuntary episodes of movement of the eye.
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More over, while the abducens and thetrochlearnerveeach innervate one specific muscle, the oculomotor nerve has many functions including eyelid retraction and pupil constriction.
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It sometimes receives a filament from thetrochlearnerve, but this is possibly derived from the branch that goes from the ophthalmic to thetrochlearnerve.
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To compensate for this, patients withtrochlearnervepalsies tilt their heads to the opposite side, in order to fuse the two images into a single visual field.
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The unique features of thetrochlearnerve, including its dorsal exit from the brainstem and its contralateral innervation, are seen in the primitive brains of sharks.
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