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Divergence paresis: a nonlocalizing cause of diplopia
1Department of Neurology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08901, USA.
Summary
Divergence paresis, an uncommon cause of acquired double vision, is linked to various central nervous system diseases. This study suggests it
Area of Science:
- Neuro-ophthalmology
- Neurology
Background:
- Divergence paresis causes acquired, uncrossed diplopia (double vision) at distance with near fusion.
- The underlying causes and the existence of a specific divergence neural center remain debated.
Purpose of the Study:
- To investigate the causes, clinical features, and localizing significance of divergence paresis.
Main Methods:
- Retrospective chart review of 15 patients with divergence paresis (1983-1998).
- All patients underwent neuroimaging and detailed ocular motility testing.
- Esotropia was measured in prism diopters for 14 patients.
Main Results:
- Causes included CNS microangiopathy/infarct (7 patients), idiopathic (3), and various other neurological conditions.
- Mean maximum esotropia was 10.4 prism diopters, with no correlation to etiology or lesion site.
- No common lesion site or increased intracranial pressure was found, even with posterior fossa disease.
Conclusions:
- Divergence paresis is an uncommon cause of acquired horizontal diplopia, associated with diverse CNS diseases.
- It can be mimicked by myasthenia gravis.
- The lack of a consistent lesion suggests divergence paresis is nonlocalizing, possibly involving diffuse neural structures or impaired inhibition.
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