滑车神经麻痹滑车神经麻痹很少单独出现，多与其他2对颅神经同时受累。滑车神经麻痹时，如不进行复视检查则不易识别。其鉴别诊断参见动眼神经麻痹。外展神经麻痹（一）桥脑出血及肿瘤细菌与面神经在桥脑中关系密切，这两个神经的核性或束性麻痹常同时存在，表现为病侧外展及面神经的麻痹和对侧偏瘫，称为Millard-Gubler氏征群。起病常较突然并迅速昏迷，双瞳孔针尖样改变。根据临床表现结合CT、MRI检查诊断不难确立。（二）岩尖综合征急性中耳炎的岩骨尖部局限性炎症及岩骨尖脑膜瘤可引起外展神经麻痹，并伴有听力减退及三叉神经分布区的疼痛，称为Gradenigo氏征群；X线摄片可发现该处骨质破坏或炎症性改变。结合病史及CT检查可确立诊断。（三）鼻咽癌外展神经在颅底前部被侵犯的原细菌以鼻咽癌zui为多见，其次为海绵窦内动脉瘤及眶上裂区肿瘤。中年病人出现单独的外展神经麻痹或同时有海绵窦征群的其它表现时，应首先考虑鼻咽癌的存在。常伴有鼻衄、鼻塞，可出现颈淋巴结肿大，作鼻咽部检查、活检、颅底X线检查可确诊。滑车神经是十二对颅神经中的一对，按其在脑干从上到下的排列顺序用罗马数字表示为Ⅳ对颅神经，它和动眼运动神经、滑车神经起自中脑上丘平面动眼神经核下端的滑车神经核，其纤维走向背侧顶盖，绕大脑脚外侧前行，穿入海绵窦外侧壁，经眶上裂入眶内，分布于上斜肌，支配此肌。为第Ⅳ对脑神经，其主要含有支配上斜肌的躯体传出纤维。它的始核是滑车神经核，位于中脑下丘水平，大脑导水管腹侧，由前髓帆出脑，先经大脑脚绕至脑底，再向前行至蝶鞍，穿入海绵窦外侧壁，至海绵窦前端，滑车神经行至动眼神经的外上方，并经总腱环的外侧，与额神经等一起经眶上裂入眶。在眼眶内，滑车神经越过上直肌和上睑提肌，从上斜肌的眶面进入该肌。滑车神经(troc细菌lear nerve)是惟一发自脑干背面的神经，也是zui细的脑神经，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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