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A Few Facts About 4th Nerve Palsy. A little known or understood disorder, 4th Nerve Palsy is an eye disorder in which the usual symptom is that of double vision.In this particular case, double vision means the image seen through one eye appears to be slightly above the image seen by the other eye. The exact cause of this disorder is not always known.hen this nerve suffers from a disorder, such as palsy, the movement of the eye is affected. The eye's gaze will tend to drift upward and perhaps slightly inward. The upward drift of the eye's gaze is called hypertropia.
Etiology. Third cranial (oculomotor) nerve disorders that cause palsies and affect the pupil commonly result from aneurysms (especially of the posterior communicating artery) and transtentorial brain herniation (see Brain herniation. ) and less commonly from meningitis affecting the brain stem (eg, TB meningitis).The most common cause of palsies that spare the pupil, particularly partial palsies, is ischemia of the 3rd cranial nerve (usually due to diabetes or hypertension) or of the midbrain.Occasionally, a posterior communicating artery aneurysm causes oculomotor palsy and spares the pupil. and less commonly from meningitis affecting the brain stem (eg, TB meningitis). The most common cause of palsies that spare the pupil, particularly partial palsies, is ischemia of the 3rd cranial nerve (usually due to diabetes or hypertension) or of the midbrain.