Bilateral trochlear nerve paresis in hydrocephalus

John R. Guy, William F. Friedman, J. Parker Mickle

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19 Scopus citations


Three patients with nonneoplastic hydrocephalus had bilateral paresis of the trochlear nerves. Associated signs, including paresis of upgaze, light-near dissociation of the pupils, and convergence-retraction nystagmus, suggested rostral involvement of the mesencephalon. Trochlear nerve paresis and accompanying signs improved after revision of ventricular shunts in two patients. Bilateral trochlear nerve paresis may be a localizing sign of involvement of the superior medullary velum (the anatomic site of trochlear nerve decussation) by a dilated sylvian aqueduct and/or downward pressure from an enlarged III ventricle.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalJournal of Clinical Neuro-Ophthalmology
Issue number2
StatePublished - Jun 1989
Externally publishedYes


  • Hydrocephalus
  • Parinaud’s syndrome
  • Trochlear nerve paresis

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology


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