A Case of Trochlear Nerve Schwannoma Presenting with Binocular Diplopia

Hyun Ju Kee; Yung Ju Yoo; Jae Hyoung Kim; Hee Kyung Yang

doi:10.3341/JKOS.2016.57.11.1812

Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010465

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Kee, Yoo, Kim, and Yang: A Case of Trochlear Nerve Schwannoma Presenting with Binocular Diplopia

Case Report

J Korean Ophthalmol Soc 2016;57(11):1812-1816.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1812

A Case of Trochlear Nerve Schwannoma Presenting with Binocular Diplopia

Hyun Ju Kee, MD¹, Yung Ju Yoo, MD¹, Jae Hyoung Kim, MD, PhD², Hee Kyung Yang, MD¹

¹Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

²Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Address reprint requests to Hee Kyung Yang, MD Department of Ophthalmology, Seoul National University Bundang Hospital, #82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: 82-31-787-7381, Fax: 82-31-787-4057 E-mail: nan282@snu.ac.kr

Received 7 July 2016 Revised 15 August 2016 Accepted 12 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of unilateral trochlear nerve schwannoma in a patient without neurofibromatosis.

Case summary

A 58-year-old male presented with acute onset of diplopia which developed 10 days prior. Alternate prism cover test, ductions and versions and Bielschowsky three-step test were compatible with left superior oblique muscle palsy. High-reso-lution magnetic resonance imaging showed a 6-mm-sized lobulated mass in the cisternal segment of the left trochlear nerve passing lateral to the brainstem. An additional thin-section gadolinium-enhanced orbit magnetic resonance imaging showed definite enhancement in the entire portion of the lobulated mass, compatible with a trochlear nerve schwannoma. Diplopia was managed conservatively with prism glasses and regular follow-up examinations were recommended without further treatment.

Conclusions

A trochlear nerve tumor should be considered in adults who develop diplopia associated with acquired superior oblique muscle palsy.

Keywords: Acquired superior oblique muscle palsy, Trochlear nerve schwannoma, Trochlear nerve tumor

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Figure 1.

Photographs of the nine cardinal positions of gaze. The left superior oblique muscle shows underaction, without definite overaction of the left inferior oblique muscle.

Figure 2.

High-resolution magnetic resonance imaging of the trochlear nerve. (A, B) Axial T2-weighted images at the lower midbrain and upper pons reveal a 6 mm-sized lobulated trochlear nerve mass with low signal intensity (arrows). Sagittal (C) and axial (D) planes of gadolinium-enhanced T1-weighted images show a well circumscribed, homogeneously enhancing lesion (arrows) originating from the trochlear nerve in the left ambient cistern.

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