Trochlear (Fourth Cranial Nerve) Palsy and Head Tilt!

[gear2d]

Was wondering which way do patients tilt their head in a CN IV lesion. I am getting mixed info:
(Correct me if I am wrong, but the patient's eye that is affected is isplateral to the lesion.)

Kaplan -> Away from lesion

FA 2010 -> Toward the lesion

HY Neuroanatomy 4th ed -> Toward lesion

[XpaezX]

Its toward lesion i checked with some neurologists and neurosurgeons (my dad is one) and they all agreed it was toward lesion, i also had the same problem and had to ask the experts

[Hokolesqua]

The diplopia is improved when the patient tilt the head Away from the side of the lesion.
But interestingly some patient tilt the head Toward the side of the lesion (paradoxical head tilt) to create a wider separation of images to allow them to suppress or ignore one of the images.

Reference: http://emedicine.medscape.com/articl...overview#a0112

Also see this from UpToDate

Click image to enlarge

Again they mentioned that patients turn away from the affected side.

[Hokolesqua]

Hey, let's work on these here
http://www.usmle-forums.com/usmle-st...o-lesions.html

[cnewber4]

To the guy with a neurosurgeon as a dad, it depends on if it is a trocherlar nucleus problem, or a trochlear nerve problem. Remember, CN4 exists dorsally then decussates immediately. Meaning the left CN4 nucleus is for the right SO muscle. Thus, you would turn you head towards the lesion (to left), but say your CN4 nerve is out, then right SO isn't working so you turn your head to the left (away from lesion)... ask you dad, but i'm pretty sure I am right.