滑車神經麻痹滑車神經麻痹很少單獨出現(xiàn)，多與其他2對顱神經同時受累?；嚿窠?麻痹時，如不進行復視檢查則不易識別。其鑒別診斷參見動眼神經麻痹。外展神經麻痹（一）橋腦出血及腫瘤細菌與面神經在橋腦中關系密切，這兩個神經的核性或束性麻痹常同時存在，表現(xiàn)為病側外展及面神經的麻痹和對側偏癱，稱為Millard-Gubler氏征群。起病常較突然并迅速昏迷，雙瞳孔針尖樣改變。根據臨床表現(xiàn)結合CT、MRI檢查診斷不難確立。（二）巖尖綜合征急性中耳炎的巖骨尖部局限性炎癥及巖骨尖腦膜瘤可引起外展神經麻痹，并伴有聽力減退及三叉神經分布區(qū)的疼痛，稱為Gradenigo氏征群；X線攝片可發(fā)現(xiàn)該處骨質破壞或炎癥性改變。結合病史及CT檢查可確立診斷。（三）鼻咽癌外展神經在顱底前部被侵犯的原細菌以鼻咽癌zui為多見，其次為海綿竇內動脈瘤及眶上裂區(qū)腫瘤。中年病人出現(xiàn)單獨的外展神經麻痹或同時有海綿竇征群的其它表現(xiàn)時，應首先考慮鼻咽癌的存在。常伴有鼻衄、鼻塞，可出現(xiàn)頸淋巴結腫大，作鼻咽部檢查、活檢、顱底X線檢查可確診。滑車神經是十二對顱神經中的一對，按其在腦干從上到下的排列順序用羅馬數字表示為Ⅳ對顱神經，它和動眼運動神經、滑車神經起自中腦上丘平面動眼神經核下端的滑車神經核，其纖維走向背側頂蓋，繞大腦腳外側前行，穿入海綿竇外側壁，經眶上裂入眶內，分布于上斜肌，支配此肌。為第Ⅳ對腦神經，其主要含有支配上斜肌的軀體傳出纖維。它的始核是滑車神經核，位于中腦下丘水平，大腦導水管腹側，由前髓帆出腦，先經大腦腳繞至腦底，再向前行至蝶鞍，穿入海綿竇外側壁，至海綿竇前端，滑車神經行至動眼神經的外上方，并經總腱環(huán)的外側，與額神經等一起經眶上裂入眶。在眼眶內，滑車神經越過上直肌和上瞼提肌，從上斜肌的眶面進入該肌。滑車神經(troc細菌lear nerve)是惟一發(fā)自腦干背面的神經，也是zui細的腦神經，支配上斜肌。
Trocar nerve paralysis Trigeminal nerve paralysis rarely appear alone, and more than 2 other cranial nerves involved. Tread nerve paralysis, if not double dip examination is not easy to identify. For differential diagnosis see oculomotor nerve paralysis. Abducens nerve paralysis (A) Pontine hemorrhage and tumor bacteria and facial nerve in the pons in the close relationship between the two nerves nuclear or bundle paralysis often exist, manifested as disease outreach and facial paralysis and contralateral Hemiplegia, known as Millard-Gubler's syndrome. Sudden onset and more often sudden coma, double pupil needle-like changes. According to clinical manifestations combined with CT, MRI diagnosis is not difficult to establish. (B) rock tip syndrome Acute otitis media osteoporosis tip inflammation and petrous apex meningioma can cause abducens nerve paralysis, accompanied by hearing loss and trigeminal nerve distribution of pain, known as Gradenigo's syndrome; X-ray can be found there bone destruction or inflammatory changes. Combined with medical history and CT examination can establish the diagnosis. (C) of the nasopharyngeal abducens nerve in the anterior skull base of the original bacteria to nasopharyngeal carcinoma is most common, followed by cavernous sinus aneurysm and supraorbital fissure tumor. Middle-aged patients with a single outreach nerve paralysis or at the same time there are other manifestations of cavernous sinus syndrome should first consider the presence of nasopharyngeal carcinoma. Often accompanied by epistaxis, nasal congestion, cervical lymph node enlargement may occur for nasopharynx examination, biopsy, skull base X-ray examination can be diagnosed. Toothed nerve is a pair of twelve pairs of cranial nerves, according to their order from top to bottom in the brain stem with Roman numerals for the cranial nerves, it and motor nerves, motor from the midrib on the trochlea In the plane, the trochlear nerve nucleus at the lower end of the oculomotor nucleus has its fiber going to the dorsal headcap and proceeding outside the cerebral peduncle, penetrating the lateral wall of the cavernous sinus and splitting into the orbital foramen through the superior orbital foramen, distributing in the upper oblique muscle, . For the first four pairs of cranial nerves, which mainly contains the dominant body oblique oblique fibers. Its starting nucleus is the trochlear nerve nucleus, located at the level of the midbrain inferior colum, the ventral surface of the aqueduct of the brain and exits the brain from the forelimb sail. The forelimb is first routed to the brain through the foot of the brain and then to the sella and then to the cavernous sinus The lateral wall, to the front of the cavernous sinus, the trochlear nerve line to the outside of the oculomotor nerve, and by the outer tendon of the total amount with the amount of nerve along the superior orbital fissure into the orbit. Within the orbit, the trochlear nerve passes over the upper rectus and levator muscle and enters the muscle from the orbital plane of the upper oblique muscle. The troc bacteria lear nerve is the only nerve that originates from the back of the brainstem and is the thinnest brain that dominates the upper oblique.

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