Title: Seeing Double?<br/>Author: Danya Khoujah<br/><a href='http://umem.org/profiles/faculty/739/'>[Click to email author]</a><hr/><p>
Diplopia can be a challenging complaint to address in the ED. Although not all patients will require imaging, use the simplified table below to help guide the imaging study needed:</p>
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<strong>Clinical Situation</strong></p>
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<strong>Suspected Diagnosis</strong></p>
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<strong>Imaging Study</strong></p>
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Diplopia + cerebellar signs and symptoms</p>
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Brainstem pathology</p>
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MRI brain</p>
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<p>
6th CN palsy + papilledema</p>
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Increased intracranial pressure (e.g. idiopathic intracranial hypertension or cerebral venous thrombosis)</p>
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<p>
CT/CTV brain</p>
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3rd CN palsy (especially involving the pupil)</p>
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Compressive lesion (aneurysm of posterior communicating or internal carotid artery)</p>
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CT/CTA brain</p>
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Diplopia + thyroid disease + decreased visual acuity</p>
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Optic nerve compression</p>
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CT orbits</p>
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Intranuclear ophthalmoplegia</p>
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Multiple sclerosis</p>
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MRI brain</p>
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<p>
Diplopia + facial or head trauma</p>
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Fracture causing CN disruption</p>
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CT head (dry)</p>
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Diplopia + multiple CN involvement (3,4,6) + numbness over V1 and V2 of trigeminal nerve (CN5) +/- proptosis</p>
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<td style="width:119px;">
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Unilateral, decreased visual acuity</p>
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Orbital apex pathology</p>
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CT orbits with contrast</p>
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Uni- or bi-lateral, normal visual acuity</p>
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Cavernous sinus thrombosis</p>
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CT/CTV brain</p>
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</table>
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C.N.: cranial nerve</p>
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<fieldset><legend>References</legend>
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Margolin E, Lam C. Approach to a Patient with Diplopia in the Emergency Department. <span style="font-family: arial, helvetica, clean, sans-serif; font-size: 11.0045px;"><span style="border-bottom-style: initial; border-bottom-color: initial;">J Emerg Med.</span> 2018 Jun;54(6):799-806</span></p>
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