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Acute binocular diplopia: peripheral or central?

Olympia Kremmyda1, Claudia Frenzel2, Katharina Hüfner3

  • 1Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilian University, Marchioninistr. 15, 81377, Munich, Germany. olympia.kremmyda@med.uni-muenchen.de.

Journal of Neurology
|August 16, 2020
PubMed
Summary
This summary is machine-generated.

Acute diplopia is often caused by ocular motor nerve palsies (OMP). Vertigo, central ocular motor signs, and subjective visual vertical (SVV) deviation in the non-paretic eye strongly indicate a central OMP lesion.

Keywords:
Diplopia, double visionOcular motilityOcular motor nerve palsiesSubjective visual verticalVertigo

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Emergency Medicine

Background:

  • Acute diplopia presents a diagnostic challenge, particularly in emergency settings.
  • Ocular motor nerve palsies (OMP) are the most frequent cause of acute diplopia.
  • Differentiating between peripheral and central OMP is crucial for appropriate management.

Purpose of the Study:

  • To identify key clinical signs and symptoms differentiating peripheral from central OMP.
  • To determine the diagnostic value of vertigo, central ocular motor signs, and subjective visual vertical (SVV) deviation.

Main Methods:

  • Prospective evaluation of 56 patients with acute binocular diplopia (≤10 days).
  • Standardized patient history, neurological, neuro-ophthalmological, and neuro-otological examinations.
  • Inclusion of subjective visual vertical (SVV) measurement, Harms tangent screen test, and cranial MRI.

Main Results:

  • Forty-six patients diagnosed with OMP (21 peripheral, 23 central).
  • Vertigo/dizziness (43.5% vs. 9.5%), central ocular motor signs (86.7% vs. 33.3%), and pathological SVV deviation (77.3% vs. 38.9%) were significantly more frequent in central OMP.
  • The combination of these three factors yielded a 100% positive predictive value for central lesions.

Conclusions:

  • Vertigo/dizziness is a key accompanying symptom in central OMP.
  • Central ocular motor disorders and SVV deviation in the non-paretic eye are critical diagnostic signs for central OMP.
  • These findings aid in distinguishing central from peripheral OMP in acute diplopia cases.