Background: Diplopia is a common complaint in both inpatient and outpatient neurologic practice. Its causes are many, and special historical and examination features are important to localization and accurate diagnosis.
Review Summary: This review is divided into 2 sections: the first related to diagnosis and the second to treatment of binocular diplopia. In the diagnostic section, emphasis is placed on identification of historical and examination features that can help to differentiate diplopia caused by dysfunction of cranial nerves versus neuromuscular junction, or orbital extraocular muscle. Techniques available to the neurologist for examining ocular motility and ocular misalignment and focused laboratory testing to evaluate diplopia are discussed in detail. The final section covers the various treatments for binocular diplopia, with recommendations regarding the utility of each treatment for different types of diplopia.
Conclusions: A logical step-by-step approach applied to each patient with diplopia will help prevent misdiagnosis and improve patient care.
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http://dx.doi.org/10.1097/01.nrl.0000156318.80903.b1 | DOI Listing |
NMC Case Rep J
December 2024
Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Shunt dependence syndrome is a serious long-term complication characterized by symptoms and signs of increased intracranial pressure with normal-sized lateral ventricles after several years of arachnoid cyst-peritoneal shunting. It is easy to misdiagnose and overlook when combined with sinus stenosis, thus delaying treatment. Here, we present a 35-year-old man with an unexplained headache and binocular horizontal diplopia with high intracranial pressure.
View Article and Find Full Text PDFBMJ Case Rep
January 2025
Medical Oncology, Alicante Institute for Health and Biomedical Research, Alicante, Comunidad Valenciana, Spain.
The increasing use of immune checkpoint inhibitors in clinical practice is associated with a broad spectrum of immune-related adverse events, such as cardiac, rheumatological and neurological toxicities. Myocarditis is a life-threatening complication, and the concurrent development of myocarditis, myositis and/or myasthenia leads to difficulties in diagnosis, management and treatment. We describe a case presenting with this triple M overlap syndrome following pembrolizumab treatment.
View Article and Find Full Text PDFBinocular vision requires that the brain integrate information coming from each eye. These images are combined (fused) to generate a meaningful composite image. Differences between images, within a range, provide useful information about depth (stereopsis).
View Article and Find Full Text PDFCureus
November 2024
Internal Medicine, Summa Health, Akron, USA.
Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS) characterized by a classic triad of external ophthalmoplegia, ataxia, and areflexia, often following a recent infection. Understanding atypical presentations of MFS is crucial for timely diagnosis and management, as the syndrome may be mistaken for other neurological disorders. This report aims to highlight the clinical journey of the patient, including symptom onset, diagnostic challenges, and therapeutic interventions, with a discussion of the broader implications of such atypical cases in the context of MFS.
View Article and Find Full Text PDFFront Neurol
November 2024
Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
Objective: This study aimed to investigate the clinical factors that predict abnormal radiographic findings in adults with acute onset binocular diplopia.
Methods: Medical records of consecutive patients aged >20 years who presented with acute binocular diplopia were retrospectively reviewed. Patients were divided into positive and negative groups according to radiographic findings.
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