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KMID : 1235520220210030086
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Research in Vestibular Science
2022 Volume.21 No. 3 p.86 ~ p.88
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Fourth Nerve Paresis plus Crossed Horner Syndrome in Acute Leukemia
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Kim Su-Min
Kim Sung-Hee
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Abstract
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A 29-year-old patient with diplopia showed a unilateral fourth nerve palsy combined with a Horner syndrome on the opposite side. Magnetic resonance images disclosed a focal hemorrhage in the left dorsal midbrain, affecting the nucleus of the fourth nerve and adjacent oculosympathetic fibers. Further evaluations including a bone marrow biopsy confirmed acute lymphoblastic leukemia. The combination of ocular motor and oculosympathetic palsy has a distinct localizing value. Fourth nerve palsy ipsilateral to Horner syndrome locates lesion in the cavernous sinus, while contralateral fourth nerve palsy locates the lesion in the midbrain.
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KEYWORD
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Diplopia, Horner syndrome, Trochlear nerve, Hemorrhage, Leukemia
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