That's correct! CN IV, the trochlear nerve is susceptible to injury with fractures of the orbital roof near the superior orbital fissure. This case scenario involved a fall, which could easily result in a fracture. Just because a workup was undertaken to rule out a vascular accident doesn't mean it was the etiology. But why was there no double vision in the H-test untiil the patient looked to the left and down? Did you notice anything about his head position that would have corrected for the diploplia? Click continue to see more.