Accompanying neurological symptoms and signs are diagnostic hallmarks of fourth nerve palsy (4NP) from an intra-axial lesion. Due to the proximity of the trochlear nucleus and fascicles to the inferior colliculus (IC), auditory symptoms including tinnitus may occur with an intra-axial 4NP. A 53-year-old man with hypertension and diabetes developed right 4NP with a sudden worsening of tinnitus. MRI disclosed an infarction involving the trochlear fascicle and IC in the left dorsal midbrain. Tinnitus may be a symptom indicating an intra-axial lesion causing a 4NP.
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Choi et al. (2010) studied this question.
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