Analysis of Peripapillary Vessel Density in Ethambutol-induced Optic Neuropathy Using Optical Coherence Tomography Angiography

Purpose@#To investigate the changes in peripapillary and macular vessel density in ethambutol-induced optic neuropathy using optical coherence tomography angiography (OCTA). @*Methods@#The medical records of patients diagnosed with ethambutol-induced optic neuropathy were analyzed retrospectively. Patient age, sex, daily dose (mg/day/kg), treatment duration, best-corrected visual acuity (logMAR), color vision (Ishihara color plate tests), and mean deviation of visual field test were evaluated in non-pathological individuals with age and sex controlled as the normal control group. Peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell/inner plexiform layer (GC/IPL) thickness, radial peripapillary capillary (RPC) density, and macular superficial capillary plexus (SCP) density were also compared between the patient and control groups. @*Results@#The study included 22 patient eyes and 31 control group eyes. Comparing the OCTA results between the groups, there were no significant differences in peripapillary RNFL thickness, but the temporal RPC density was significantly (p = 0.025) lower in the patient group (48.00 ± 8.23%) than in controls (52.39 ± 5.58%). For macular structures, the mean GC/IPL thickness and whole SCP density were lower in the patients (p = 0.001 and p = 0.008, respectively). In the patients, the changes in peripapillary RNFL thickness and RPC density were significantly positively correlated (r = 0.811, p < 0.001), as were the mean macular GC/IPL thickness and whole SCP density (r = 0.445, p = 0.037). @*Conclusions@#Patients with ethambutol-induced optic neuropathy had significantly lower temporal RPC and macular SCP densities. Ethambutol toxicity may affect not only axonal degeneration but also peripapillary and macular vascular function.

Spontaneous Recovery of Traumatic Unilateral Superior Oblique Palsy and Ocular Factors for Predicting Prognosis

Purpose@#This study evaluated the prognosis of patients with traumatic unilateral superior oblique palsy (SOP) and clinical factors associated with spontaneous resolution. @*Methods@#Medical records of patients with traumatic unilateral SOP who visited two hospitals (Yeungnam University Hospital and Daegu Catholic University Medical Center) between January 2015 and June 2020 were reviewed retrospectively. When traumatic unilateral SOP did not recover within at least 1 year of follow-up, no spontaneous resolution was considered. Both traumatic and ocular factors were evaluated to evaluate their association with spontaneous recovery. @*Results@#Fifty-nine patients (mean age, 52.6 years; 48 male patients) were enrolled in this study. The mean interval from trauma to initial presentation was 3.9 months. The mean vertical deviation at initial presentation was 6.34 ± 5.22 prism diopters (PD) (range, 0–25 PD). During the mean 24.1-month follow-up period, 28 patients (47.5%) achieved spontaneous resolution of SOP. Thirteen patients underwent surgical treatment for SOP. Vertical deviation <6 PD at the initial visit and low fundus torsion in the nonparetic eye and both eyes were significantly associated with spontaneous recovery (p < 0.05, logistic regression analysis). Traumatic factors, including the trauma type, presence of intracranial lesion, loss of consciousness, and Glasgow Coma Scale score, were not associated with spontaneous recovery. @*Conclusions@#In this multicenter study, spontaneously recovery was achieved in 47.5% patients with traumatic unilateral SOP. Even mild head trauma can lead to permanent SOP. Ocular factors, including the angle of deviation and fundus torsion, may better predict spontaneous resolution than traumatic factors in patients with traumatic unilateral SOP.

Correlation between Frisby-Davis Distance Stereoacuity Scores and Long-term Surgical Outcomes in Intermittent Exotropia

Purpose@#We analyzed postoperative Frisby-Davis distance (FD2) stereotest scores and changes in the angle of deviation, and the correlation between postoperative FD2 stereotest scores and long-term surgical outcomes, in patients with intermittent exotropia. @*Methods@#This retrospective study included patients aged less than 12 years with intermittent exotropia who underwent at least 28 months of postoperative follow-up. We analyzed the changes in the postoperative angle of deviation and preoperative and postoperative Titmus and FD2 stereotest scores. Surgical success rates at 28 months postoperatively were compared between the good (FD2 at 10 months postoperatively ≤ 10 arcsec) and bad (FD2 at 10 months postoperatively ≥ 15 arcsec) stereotest groups. Surgical success was defined as a horizontal deviation on distance measurement of 5 prism diopter (PD) esodeviation to 10 PD exodeviation at 1 year postoperatively. @*Results@#This study included 101 patients. No significant difference was identified between preoperative and postoperative Titmus test scores. However, the FD2 stereotest scores were significantly improved at 10 months postoperatively (p = 0.001). A significant, positive correlation was observed between FD2 stereotest scores at 10 months postoperatively and the angles of deviation at distance at 10, 16, 22, and 28 months postoperatively (p ≤ 0.001 for all). The surgical success rates at 28 months postoperatively were 73.1% and 43.5% in the good and bad stereotest groups, respectively (p = 0.008). @*Conclusions@#Distance stereoacuity within 1 year postoperatively correlated with the postoperative angle of deviation at distance. Good distance stereoacuity (i.e., < 10 arcsec) within 1 year postoperatively correlated with a higher surgical success rate compared to bad distance stereoacuity.

A Case with Bilateral Dural Arteriovenous Fistulae Manifesting as Sequential Trochlear, Oculomotor Nerve Palsies

Purpose@#We report a patient with bilateral dural arteriovenous fistulae (DAVF) who initially presented with unilateral, isolated trochlear nerve palsy; and later with contralateral, oculomotor nerve palsy.Case summary: A 72-year-old male without any underlying disease or a trauma history visited with sudden vertical diplopia in both eyes that had developed 5 days prior. Brain magnetic resonance imaging (MRI) performed before his first visit was unremarkable. The eye movement test revealed hyperdeviation and limitation of downgaze in the left eye; we thus suspected unilateral, ischemic trochlear nerve palsy and this was indeed observed. However, the diplopia did not improve and limitations of the upper, medial gaze of the right eye developed after 3 months. Follow-up examinations (orbital computed tomography, brain MRI, and cerebral angiography) revealed bilateral DAVF running from the left to the right. He underwent gamma-knife radiosurgery; then the eye movement limitations and diplopia improved. @*Conclusions@#Diplopia manifesting as paralysis in an elderly patient may be caused by DAVF; the diplopia may not always be the common ischemic paralytic strabismus. DAVF should be considered during differential diagnosis and further radiological examinations may be needed.

A Study on Dispatched Nursing during the Japanese Colonial Era

Purpose@#This study aimed to explore the characteristics of dispatched nursing, a type of private nursing called Hasutsu, during the Japanese colonial period in Korea. This specialized and professional nursing was a form of a dispatched nursing service provided by nurses associations. @*Methods@#This study reviewed a literature on visiting nursing, a literature on dispatched nursing, focusing on data collected during the Japanese colonial period from August 1910 to August 1945. Study design was a document research study of historical records. Results: The dispatched nursing service was established by the Japanese nurses in Korea. More than 60 nurses associations operated to meet the demands in the modern Korean nursing period. It was found that some associations tried to raise the nursing fees. Also, the practice of employing visiting nurses who did not have a license was criticized severely in the newspapers. Considering that the data was limited in this study, the existence of Korean nurses association employing Korean visiting nurses has not been specifically identified. @*Conclusion@#The findings reveal some aspects of dispatched nursing provided by the nurses associations in that era. The nurses associations developed their own specialized service independently by dispatching nurses to fulfill the needs of people not only with cheaper nursing fares than hospitals but with convenient nursing care services, including customized care for infectious diseases. A study of modern historical records of Korean nurses would facilitate deeper research into Korean nursing history.

A Study on Dispatched Nursing during the Japanese Colonial Era

Purpose@#This study aimed to explore the characteristics of dispatched nursing, a type of private nursing called Hasutsu, during the Japanese colonial period in Korea. This specialized and professional nursing was a form of a dispatched nursing service provided by nurses associations. @*Methods@#This study reviewed a literature on visiting nursing, a literature on dispatched nursing, focusing on data collected during the Japanese colonial period from August 1910 to August 1945. Study design was a document research study of historical records. Results: The dispatched nursing service was established by the Japanese nurses in Korea. More than 60 nurses associations operated to meet the demands in the modern Korean nursing period. It was found that some associations tried to raise the nursing fees. Also, the practice of employing visiting nurses who did not have a license was criticized severely in the newspapers. Considering that the data was limited in this study, the existence of Korean nurses association employing Korean visiting nurses has not been specifically identified. @*Conclusion@#The findings reveal some aspects of dispatched nursing provided by the nurses associations in that era. The nurses associations developed their own specialized service independently by dispatching nurses to fulfill the needs of people not only with cheaper nursing fares than hospitals but with convenient nursing care services, including customized care for infectious diseases. A study of modern historical records of Korean nurses would facilitate deeper research into Korean nursing history.

The Influences of Grit, Emotional Labor and Organizational Intimacy on Nurses' Intention to Stay in Comprehensive Nursing Care Service Units / 재활간호학회지

Purpose@#The purpose of this study was to identify the impact of grit, emotional labor and organizational intimacy on nurses' intention to stay to work in comprehensive nursing care service units. @*Methods@#A cross-sectional descriptive design was used. Participants were 192 nurses working in comprehensive nursing care service units at a general hospital. Data were collected using self-report questionnaires, and analyzed using the SPSS/WIN 23.0 program for descriptive statistics, independent t-test, one-way ANOVA, post-hoc Scheffé test, Pearson's correlation, and multiple regression. @*Results@#Intention to stay was positively correlated with grit (r=.28, p=.002), opportunity of forming (r=.17, p=.022), and expansion of intimacy (r=.24, p=.001). The influencing factors on nurses' intention to stay in comprehensive nursing care service units were the work department (β=.23, p=.002) and grit (β=.21, p=.003). Grit and work department explained 13.0% of variances of nurses' intention to stay. @*Conclusion@#The results of this study suggest that nurse's grit plays an important role in continuing to work in a comprehensive nursing service unit. It is recommended to develop a program that includes strategies for improving grit.

Landscape of Actionable Genetic Alterations Profiled from 1,071 Tumor Samples in Korean Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data. MATERIALS AND METHODS: To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared. RESULTS: We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration. CONCLUSION: In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.

Effects of Delirium Management Program on Nursing Practice and Nurses' Stress in Comprehensive Nursing Care Service Units / 재활간호학회지

PURPOSE@#This study was conducted to examine the effects of a delirium management program on nursing practice and nurses' stress in comprehensive nursing care service units.@*METHODS@#A non-equivalent control group pretest-posttest design was used. The participants were 70 nurses in comprehensive nursing care service units. The nurses were assigned to either a experimental group (n=35) or a control group (n=35). The experimental group received a delirium management program. Data were analyzed using χ² test, Fisher's exact test, independent t-test and ANCOVA.@*RESULTS@#The experimental group showed higher nursing practice than the control group (F=7.86, p=.007). The experimental group showed lower nurses' stress than the control group (F=10.73 p=.002).@*CONCLUSION@#The findings indicated that a delirium management program was an effective intervention to improve nursing practice and reduce nurses' stress in comprehensive nursing care service units.

Effects of Job Embeddedness, Nursing Work Environment, and Nursing Professionalism on Turnover Intention in Nurses Working at Rehabilitation Hospitals / 재활간호학회지

PURPOSE@#This study was conducted to identify the effects of job embeddedness, nursing work environment, and nursing professionalism on turnover intention in nurses working at rehabilitation hospitals.@*METHODS@#This descriptive study employed a cross-sectional research design. Questionnaires were collected from May to June, 2019. Participants were 200 nurses from three rehabilitation hospitals in Seoul and Gyunggi province. Data were analyzed using independent t-test, ANOVA, Pearson correlation, stepwise multiple regression.@*RESULTS@#Mean scores for turnover intention, nursing work environment, nursing professionalism. and job embeddedness were 3.21±0.65, 2.90±0.43, 3.06±0.24, and 3.11±0.40, respectively. Turnover intention was negatively correlated with job embeddedness, nursing practice environment, and nursing professionalism. Nursing work environment was the most important predictor in turnover intention, followed by job embeddedness.@*CONCLUSION@#The findings in this study indicated that we need to investigate the level of job embededness, nursing work environment, and nursing professionalism in nurses working at rehabilitation hospitals. Hospital managers should develop and apply appropriate policies and strategies to reduce nurses' turnover intention, improve nursing work environment and enhance the level of job embededness.

Factors related to Coronary Artery Disease in Korean Adults: Based on the Korean National Health and Nutrition Examination Survey 2013~2015 / 재활간호학회지

PURPOSE: The purpose of this study was to identify the factors related to coronary artery disease in Korean adults. METHODS: This study analyzed cross-sectional data collected from 11,103 Korean adults aged 40 years and older who participated in Korean National Health and Nutrition Survey VI (2013~2015). Data were analyzed with descriptive statistics, Rao-Scott χ² test and logistic regression with IBM SPSS v.23. Logistic regression examined whether variables in 3 domains - socio-demographic, lifestyle and health related factors were associated with coronary artery disease. RESULTS: The prevalence of coronary artery disease was 3.16% of the population. Coronary artery disease was associated with older age, spouse, smoking, stress, obesity, poorer self reported health, hypertension, dyslipidemia, and diabetes mellitus. CONCLUSION: This study suggested that comprehensive nursing intervention should include associated variables in order to reduce the prevalence of coronary artery disease.

Preoperative Lymphocyte-Monocyte Ratio Ameliorates the Accuracy of Differential Diagnosis in Non-Metastatic Infiltrative Renal Masses

PURPOSE: Distinguishing infiltrative renal cell carcinoma (RCC) from transitional cell carcinoma (TCC) is a challenging issue due to their radiologic similarities. We evaluated systemic inflammatory biomarkers as parameters for distinguishing tumor types. MATERIALS AND METHODS: A computerized search of medical records from November 2005 to October 2015 identified 116 patients with infiltrative renal masses who were difficult to diagnose confirmatively in radiological study. We investigated the diagnostic efficacy among these patients with their preoperative absolute neutrophil counts (ANC), absolute lymphocyte counts (ALC), absolute monocyte counts (AMC), neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). RESULTS: The infiltrative RCC group demonstrated significantly lower ALC {1449/µL (1140–1896), median [interquartile range (IQR)]} than the TCC group [1860/µL (1433–2342), p=0.016]. LMR [median (IQR)] also was lower in the infiltrative RCC group [2.98 (2.32–4.14) vs. TCC group 4.10 (2.86–6.09); p=0.011]. In subgroup analysis, non-metastatic infiltrative RCC showed lower ALC and LMR and higher NLR than non-metastatic TCC. Within non-metastatic infiltrative renal masses, multivariate logistic regression analysis revealed that younger patient age and lower LMR were associated with infiltrative RCC [odds ratios (OR) 0.874, p=0.024 and OR 0.461, p=0.048, respectively]. Receiver operating characteristic curve analysis showed that younger age and lower LMR were highly predictive of non-metastatic RCC (area under the curve=0.919, p<0.001). CONCLUSION: Age and LMR were significantly different between patients with infiltrative renal mass. These are potential markers for distinguishing between infiltrative RCC and TCC without metastasis.

Influencing Factors on Osteopenia and Osteoporosis in Korean Aged 50 Years and Above / 재활간호학회지

PURPOSE: The purpose of this study was to identify the influencing factors on osteopenia and osteoporosis in Korean aged 50 years and above. METHODS: Data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-1, 2010) were obtained and 2,773 subjects who got bone density test and were classified “normal, osteopenia or osteoporosis” were selected. Data were analyzed χ² test, ANOVA, Scheffé test and logistic regression using the SAS 9.4. RESULTS: Gender, age, days of flexibility exercise, vitamin D in blood and weight were found to be influencing factors for osteoporosis in Korean aged 50 years and above. Gender. age and smoking were found to be influencing factors for osteopenia in Korean aged 50 years and above. CONCLUSION: This study suggested that nursing intervention should include exercise promotion, intake vitamin D, smoking cessation and weight control program in order to reduce the prevalence of osteoporosis and osteopenia.

Comparison of Double Maddox Rod Test and Bagolini Striated Lens Test for Superior Oblique Palsy

PURPOSE: We compared the results of the double Maddox rod test (DMRT), which is commonly performed in clinics as a subjective torsion test for superior oblique muscle palsy, with those of the Bagolini striated lenses test (BSLT) in a least dissociating condition to predict the cyclofusional capacity. METHODS: Twenty-five patients with acquired superior oblique muscle palsy were tested for degree of subjective torsion with DMRT and BSLT in primary position and down-gaze in Daegu Catholic University Hospital from May 2014 to March 2015. DMRT was performed in a dark room and BSLT in a lighted room. RESULTS: Mean extorsional degree in primary position was 3.40 ± 2.58° on DMRT and 1.88 ± 2.92° on BSLT, a significant difference (p = 0.000). In down-gaze, mean extorsional degree was 4.16 ± 2.90° with DMRT and 2.40 ± 2.90° with BSLT (p < 0.001). CONCLUSIONS: The subjective torsional measurement with BSLT was significantly smaller than with DMRT, and the cyclofusional capacity in patients with acquired superior oblique palsy was 1.5° in primary position and 1.8° in down-gaze. BSLT is helpful in addition to DMRT and fundus photograph for the evaluation of cyclotropia in patients with superior oblique muscle palsy, and this test may yield clinically important information for predicting the cyclofusional capacity of patients with superior oblique muscle palsy.

Effects of Forced Air Warming on Body Temperature, Shivering and Pain in Laparoscopic Cholecystectomy Patients / 기본간호학회지

PURPOSE: The purpose of this study was to examine the effects of forced air warming on intraoperative and postoperative body temperature, postoperative shivering and pain in patients undergoing laparoscopic cholecystectomy. METHODS: A quasi-experimental design with nonequivalent control group was utilized. Fifty eight patients scheduled for laparoscopic cholecystectomy were recruited and assigned to the experimental group (n=29) or control group (n=29). For the experimental group, forced air warming was applied from right after induction and up to one hour after surgery. Body temperature, shivering score and pain score were measured in both groups at 15 minute intervals. Data were collected from September, 2013 to April, 2014. Data were analyzed using t-test, Bonferroni test and repeated measures ANOVA. RESULTS: The experimental group showed higher body temperature than the control group during surgery. After surgery the experimental group showed higher body temperature, lower shivering and less pain compared to the control group. CONCLUSION: Results show that forced air warming is effective in enhancing body temperature and reducing shivering and pain. Therefore, forced air warming is recommended as an operative nursing intervention.

Effects of Korean Hand Acupressure on Pain and Abdominal Bloating of Patients Receiving Laparoscopic Hysterectomy / 재활간호학회지

PURPOSE: This study aimed to investigate the effects of Korean hand acupressure on pain and abdominal bloating of patients receiving laparoscopic surgery. METHODS: This study was a quasi-experimental design using a non-equivalent control group pre-post test. The experimental group and the control group were 39 patients each who were hospitalized at gynecology ward of a hospital located in Gyeonggi-do. The experimental group received Korean hand acupressure therapy on the meridian point: A5, A6, H3, H7, I38 for 48 hours immediately after the surgery. Pain and abdominal bloating were measured at 5 times. Data were analyzed using SPSS/Win 18.0. RESULTS: The experimental group showed lower pain score than the control group (p<.001). While there was no significant difference in abdominal bloating (p=.528), the time effect was significantly different (p<.001). CONCLUSION: The findings indicate that Korean hand acupressure reduces pain and abdominal bloating of laparoscopic surgery patients.

Lee Jungsook, a Korean Independence Activist and a Nurse during the Japanese Colonial Period / 의사학

This article examines the life of Lee Jungsook, a Korean nurse, as a independence activist during the Japanese colonial period. Lee Jungsook(1896-1950) was born in Bukchung in Hamnam province. She studied at Chungshin girl's high school and worked at Severance hospital. The characteristics and culture of her educational background and work place were very important factors which influenced greatly the life of Lee Jungsook. She learned independent spirit and nationalism from Chungshin girls' high school and worked as nurse at the Severance hospital which were full of intense aspiration for Korea's independence. Many of doctors, professors and medical students were participated in the 3.1 Independence Movement. Lee Jungsook was a founding member of Hyulsungdan who tried to help the independence activists in prison and their families and worked as a main member of Korean Women's Association for Korean Independece and Kyungsung branch of the Korean Red Cross. She was sent to jail by the Japanese government for her independence activism. After being released after serving two years confinement, she worked for the Union for Women's Liberation as a founding member. Lee Joungsook was a great independence activist who had a nursing care spirit as a nurse.

A Case of Erdheim-Chester Disease with Diplopia

PURPOSE: We present a case of Erdheim-Chester disease (ECD) with diplopia. CASE SUMMARY: A 56-year-old woman came to the hospital with a 6-week history of diplopia on left lateral gaze. The right eye showed mildly limited adduction. Humphrey automated perimetry demonstrated inferior bitemporal quadrantanopia. Orbital and brain magnetic resonance imaging revealed well-defined orbital masses in both intraconal orbits with homogenous enhancement, as well as multiple masses of homogenous signal intensity in the brain. Systemic evaluation showed involvement of the long bones, and retroperitoneum, but no involvement of the heart, or lungs. Incisional biopsy of the right orbital mass was performed. Histopathological examination showed numerous lipid-laden histiocytes and few multinucleated Touton giant cells. Immunohistochemical staining showed positivity for CD68, but negativity for CD1a, and ECD was therefore diagnosed. The patient received treatment with radiation therapy and interferon-alpha, but died due to sepsis secondary to urinary tract infection after 2 months. CONCLUSIONS: Except exophthalmos, diplopia may be the only initial symptom of an orbital mass. Although rare, the possibility of ECD should be considered in the differential diagnosis of both retrobulbar and orbital masses with diplopia.

Effects of Tai Chi Exercise on Physical Fitness and Quality of Life in Elderly Women / 재활간호학회지

PURPOSE: This study was performed to investigate the effects of Tai Chi exercise on physical fitness and quality of life (QOL) in elderly women. METHODS: This study was designed as a quasi-experimental, nonequivalent control group pre-post test design. The subjects were elderly women over 60 years old who enrolled senior citizen centers and elderly welfare center. Thirty-three people were conveniently assigned to an experimental group (n=15) or a control group (n=18). The data were collected from September 2009 to May 2010. The experimental group was trained Tai Chi exercise for 8 weeks (one hour Tai Chi classes twice a week and once a week by themselves at home). Data were analyzed by Fisher's exact test, chi2-test and independent t-test. RESULTS: The experimental group experienced significant improvements in flexibility. The experimental group experienced significant improvements in physical component summary (p=.017) and mental component summary (p=.027) of QOL. CONCLUSION: Tai Chi exercise can be used as a nursing intervention for improvement of physical fitness and QOL in elderly women.

A Case of Bilateral Trochlear Nerve Palsy Following Cisternography

PURPOSE: To report a case of bilateral trochlear nerve palsy following cisternography. CASE SUMMARY: A 43-year-old male with intermittent watery rhinorrhea persisting for 3 months visited the neurosurgery department of our institute. His past medical history included removal of a pituitary adenoma 22 years prior to presentation. Cerebrospinal fluid leakage was suspected and cisternography was performed. The patient was referred to our ophthalmology department for diplopia 3 days after the cisternography. An alternate prism cover test showed 5 prism diopter (PD) right hypertrophia in the primary position, and underaction of bilateral superior oblique muscles and overaction of the left inferior oblique muscle. A positive Bielschowsky test with the head tilted to either side was observed and excyclotorsion was 9degrees on the double Maddox rod test. The patient was diagnosed with bilateral trochlear nerve palsy. After 2 years of follow-up, diplopia persisted and recession of the bilateral inferior oblique muscles was performed. After the surgery, diplopia disappeared, the fundus photography showed no excyclotorsion, and the double Maddox rod test indicated 3degrees of excyclotorsion. CONCLUSIONS: Cisternography should be carefully performed due to the possibility of bilateral trochlear nerve palsy, an extremely rare but possible occurrence following the procedure.