Winner of Nov 2008 PIO Quiz and answer

What is the diagnosis?

Answer: Three of the four children exhibit a left head tilt consistent with congenital 4th cranial nerve palsy. Right congenital fourth nerve palsy in all children except the one on the upper-right.

Quick Review: Congenital Fourth Nerve Palsies

• Head tilt opposite the side of the palsy.
• Facial asymmetry.
• Large vertical fusional amplitudes.

We congratulate the winner of the Nov 2008 Pio Quiz, Janet Kim, MD!