A trochlear stroke

Abstract

A 51 year-old right-handed male physician had diplopia. His past medical history included refractive error, hypertension, dyslipidemia, and reactive hypoglycemia. He was involved in a motor vehicle accident in 1996, with cervical whiplash, but no associated head trauma or loss of consciousness. In 1996, the same year of his accident, he started experiencing binocular, vertical diplopia, although he did not relate it clearly to the accident. He also noted some associated dizziness, but no definite oscillopsia and no other neurologic complaints. During ophthalmologic evaluation for refractive surgery in 1997, vertical nystagmus was noted. MRI in 1997 and again in 1998 were interpreted as normal. Neuro-ophthalmologic evaluation in 2004 revealed a left head tilt, 70% of normal depression of the right eye when adducted, right hypertropia that decreased in up-gaze, increased in down-gaze, and increased with right head tilt, and a variable up-beat nystagmus in primary gaze, which worsened on …