Abstract
Introduction: The trochlear nerve (cranial nerve IV) innervates the superior oblique muscle and is critical for eye movement control. As the thinnest and longest cranial nerve, it has unique anatomical and functional characteristics. Trochlear nerve palsy results in paralytic strabismus and diplopia, with treatment approaches varying based on etiology.Aim: To synthesize and analyze existing literature on the prevalence and etiology of trochlear nerve palsy (TNP).Methods: Literature review of major studies examining TNP, focusing on etiological distribution, clinical presentation, and demographic patterns across different patient populations.Results: Congenital TNP prevalence varied between 8-77.45% across studies, with most common presentation in the fourth decade of life. Traumatic causes represented 20-35% of cases, predominantly affecting males (60%) in their third decade. Microvascular causes accounted for 13-24% of cases, mainly presenting in the seventh decade and associated with hypertension and diabetes. Idiopathic cases ranged from 4-23%. Rare causes included tumors (9%) and other miscellaneous conditions (15%). Diplopia was more frequently reported in acquired versus congenital cases.Conclusions: TNP presents with diverse etiologies, varying significantly across studies. Standardized diagnostic criteria and longitudinal studies are needed for better categorization and understanding of disease progression. Early recognition of underlying causes is crucial for targeted treatment strategies, particularly in patients with trauma history or systemic vascular conditions.
Published Version
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