What you see is NOT what you get: Imaging differentials of diplopia.

Congress:

ECR 2018

Poster Number:

C-1429

Type:

Educational Exhibit

Keywords:

Education and training, Diagnostic procedure, Computer Applications-Detection, diagnosis, MR-Spectroscopy, MR-Angiography, MR, Neuroradiology brain, Eyes, CNS

Authors:

S. Neelakantan, A. Anil Kumar; Bangalore/IN

DOI:

10.1594/ecr2018/C-1429

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1429

Table 1: Anatomical structure with differentials of lesions along the...

Table 2: Regions of interest with optimum imaging strategies for evaluation of diplopia.

Fig. 1: Graphical representation of the Supra nuclear/ Nuclear components and...

Fig. 2: Line diagram of the course of the III, IV and VI cranial nerves.

Learning objectives

To understand the complex imaging anatomy of the neuro- ophthalmological relay pathway. To review the imaging appearances of the diverse spectrum of neoplastic and non- neoplastic lesions that can cause binocular diplopia.

Background

Diplopia, or double vision, is the hallmark of retinal disparity. This phenomenon usually occurs when fusion is disturbed, which is defined as the unification of visual excitations from the corresponding retinal images into a single visual percept. A complete neuro-ophthalmological examination is essential for accurate localisation. Because of a very high prevalence of structural, infectious and inflammatory causes, the patient’s age at presentation is an important consideration when working up for causes of binocular diplopia. Younger adults and pediatric patients will need comprehensive evaluation, which...

Findings and procedure details

(I) Imaging of a patient with diplopia. [4] “Red flag signs” that require immediate imaging: 1] Acute cranial nerve palsy, especially pupil-involving, 3rd nerve palsy with diplopia associated with thunderclap headache à Ruptured intracranial aneurysm. 2] Sudden onset proptosis with painful ophthalmoplegia and diplopia à Cavernous sinus thrombosis. 3] Severe headache, papilledema, lateral rectus palsy with diplopia in lateral gaze of the involved eye à false localizing sign of raised intracranial pressure. 4] History of trauma with binocular diplopia in any gaze à Extra ocular...

Conclusion

MRI is a useful diagnostic tool in identifying the site of and characterizing the pathology causing diplopia and it can also aid in the surgical approach to these lesions. We have classified these lesions based on anatomic zones and pathology to aid in reaching a focussed differential diagnosis.

Personal information

References

[1] Dhar SK, Pantola P, Vichare N, Bhargava N.Diplopia- A Practical Approach. DOS Times 2015; Vol 20, No 9: 63-66 [2] Lutwak N. Binocular Double Vision - A Review. American Journal of Clinical Medicine 2011; Vol 8, No 3:166-169 [3] Rucker J C, Tomsak R L. BinocularDiplopia- A Practical Approach. The Neurologist 2005; Vol 11 No. 2: 98-110 [4] Tamhankar MA, Volpe NJ. Management of acute cranial nerve 3,4 and 6 palsies: role of neuroimaging. Curr Opin Ophthalmol 2015, 26: 464-468 [5] Kirsch C, Black...