When is diplopia strongly suggestive of a vascular event?

Tilikete, Caroline; Vighetto, Alain

doi:10.1586/eop.09.28

Cited by 3 publications

(3 citation statements)

References 44 publications

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“…It can be associated with the ‘ocular tilt reaction’ (OTR) which is a clinical triad of skew deviation, ocular torsion and head tilt. By convention the direction of skew is given by the side of the hypotropic eye 13 20. Our patient had a right hypotropia contralateral to a left MLF lesion that was consistent with a skew deviation.…”

Section: Discussionmentioning

confidence: 57%

Unilateral internuclear ophthalmoplegia, strabismus and transient torsional nystagmus in focal pontine infarction

Haider¹

2016

BMJ Case Reports

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Vertebrobasilar stroke carries a high mortality rate and can have symptom patterns that are complex and difficult to diagnose. Isolated infarcts of the pons are uncommon and the neuro-ophthalmic presentation of pontine stroke can be quite variable. There is a paucity of cases in the literature documenting neuro-ophthalmic pathology as the sole or primary manifestation of pontine stroke. Here is presented the case of a unilateral internuclear ophthalmoplegia (INO) with concomitant skew deviation, contralesional exotropia and ipsiversive torsional nystagmus as the initial and only presenting feature of an isolated pontine stroke. This case illustrates the need to consider a cerebrovascular event early in the differential of a complex ocular motility disturbance not in keeping with specific cranial nerve palsy. It similarly highlights non-paralytic pontine exotropia and skew deviation as important causes of acute onset acquired strabismus, and transient torsional nystagmus as a rare but relevant localising feature in pontine strokes causing INO. Acute onset of this constellation of signs is highly suggestive of pontine infarction.

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Section: Discussionmentioning

confidence: 57%

Unilateral internuclear ophthalmoplegia, strabismus and transient torsional nystagmus in focal pontine infarction

Haider¹

2016

BMJ Case Reports

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“…The abducens nerve can be compressed due to a vascular anomaly in the same way that other nerves can be, but due to its long trajectory, clinical symptoms can appear late in the course of the disease [4][5][6]. Other diplopia causes such as mass lesions that protrude into the cerebellopontine cistern, infectious or inflammatory disease (usually affecting the cisternal segment) can be easier to identify due to their systemic implications and symptoms [7,8].…”

Section: Discussionmentioning

confidence: 99%

Diplopia due to a neurovascular compression

Dăscălescu

Potop

Coviltir

et al. 2022

rjo

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“…13 All six patients with an isolated CN III and both patients who had a CN III as part of dual pathology (these two cases were classified as incorrect algorithm assisted diagnoses) were correctly identified as having a CN III palsy. There is data to suggest that the likelihood of serious underlying pathology varies with the type of palsy, that is, CN III palsies are much more likely to have a serious underlying cause than a CN IV palsy, [14][15][16] hence the reason for trying to have a provisional 'algorithm assisted' diagnosis of a CN III or CN IV as opposed to a referral that simply states 'vertical diplopia -please see'. The ideal algorithm should allow the user to demonstrate very high sensitivity with respect to the most serious conditions; cranial nerve palsies and INO and also to have high levels of specificity for the more minor conditions; cataract so that all patients that need an urgent referral get one.…”

mentioning

confidence: 99%

The accuracy of the Edinburgh diplopia diagnostic algorithm

Butler

Yap

Wright

2016

Eye

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Purpose To assess the diagnostic accuracy of the Edinburgh diplopia diagnostic algorithm. Methods This was a prospective study. Details of consecutive patients referred to ophthalmology clinics at Falkirk Community Hospital and Princess Alexandra Eye Pavilion, Edinburgh, with double vision were collected by the clinician first seeing the patient and passed to the investigators. The investigators then assessed the patient using the algorithm. An assessment of the degree of concordance between the 'algorithm assisted' diagnosis and the 'gold standard' diagnosis, made by a consultant ophthalmologist was then carried out. The accuracy of the pre-algorithm diagnosis made by the referrer was also noted. Results All patients referred with diplopia were eligible for inclusion. Fifty-one patients were assessed; six were excluded. The prealgorithm accuracy of referrers was 24% (10/41). The algorithm assisted diagnosis was correct 82% (37/45) of the time. It correctly diagnosed: cranial nerve (CN) III palsy in 6/6, CN IV palsy in 7/8, CN VI palsy in 12/12, internuclear ophthalmoplegia in 4/4, restrictive myopathy in 4/4, media opacity in 1/1, and blurred vision in 3/3. The algorithm assisted diagnosis was wrong in 18% (8/45) of the patients. Conclusions The baseline diagnostic accuracy of non-ophthalmologists rose from 24 to 82% when patients were assessed using the algorithm. The improvement in the diagnostic accuracy resulting from the use of the algorithm would, hopefully, result in more accurate triage of patients with diplopia that are referred to the hospital eye service. We hope we have demonstrated its potential as a learning tool for inexperienced clinicians.

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When is diplopia strongly suggestive of a vascular event?

Cited by 3 publications

References 44 publications

Unilateral internuclear ophthalmoplegia, strabismus and transient torsional nystagmus in focal pontine infarction

Unilateral internuclear ophthalmoplegia, strabismus and transient torsional nystagmus in focal pontine infarction

Diplopia due to a neurovascular compression

The accuracy of the Edinburgh diplopia diagnostic algorithm

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