Isolated Fourth Nerve Palsy in Nontraumatic Tentorial Hemorrhage

Abstract: A 46-year-old woman being treated with warfarin for antiphospholipid antibody syndrome experienced a rise in international normalized ratio (INR) to 5.4 and developed sudden headache and diplopia. Neuro-ophthalmologic examination disclosed a right fourth nerve palsy. Noncontrast computed tomography revealed a subdural hematoma layered along the right tentorium cerebelli, directly in the path of the nerve. With normalization of the INR, the palsy markedly improved over subsequent weeks. This is a unique case of a nontraumatic subdural hematoma causing a fourth nerve palsy. Address correspondence to Jonathan D. Trobe, MD, University of Michigan, Ann Arbor, MI 48105; E-mail: jdtrobe@umich.edu The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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