and cavernous sinus disease can affect the fourth nerve, as can orbital tumors and Tolosa-Hunt syndrome. In general, these diseases affect other cranial nerves as well. Isolated damage to the fourth nerve is uncommon in these settings.

Chronic palsy

The most common cause of chronic fourth nerve palsy is a congenital defect, in which the development of the fourth nerve (or its nucleus) is abnormal or incomplete. Congenital defects may be noticed

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