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Oddly, fibers from the trochlear nucleus cross over in the trochlear decussation of the midbrain, located in the to exit dorsally, the only cranial nerve to do so.

To compensate for this, patients with trochlear nerve palsies tilt their heads to the opposite side, in order to fuse the two images into a single visual field.

Isolated damage to the fourth nerve is uncommon in these settings.

A generalized increase in intracranial pressure—, , , —will affect the fourth nerve, but the VI is usually affected first producing horizontal diplopia, not vertical diplopia.

When the eye is adducted looking toward the nose , the force of depression increases.

This definition incorporates text from a public domain edition of Gray's Anatomy 20th U.

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Lipsiae, Beer 1 4 : 1517-2224.