Res Vestib Sci.
2022 Sep;21(3):86-88. 10.21790/rvs.2022.21.3.86.
Fourth Nerve Paresis plus Crossed Horner Syndrome in Acute Leukemia
- Affiliations
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- 1Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
- KMID: 2534298
- DOI: http://doi.org/10.21790/rvs.2022.21.3.86
Abstract
- 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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