Cranial nerve palsies affecting the oculomotor (3rd), trochlear (4th) and abducens (6th) nerves are frequent causes of binocular diplopia. The abducens nerve is the most frequently affected. The diagnosis is made based on clinical history, clinical examination and paraclinical tests. Several factors are important when considering the history of these patients, mainly age, and the presence of cardiovascular risks factors (CRF) such as hypertension, diabetes and hypercholesterolemia. It is also important to determine the presence of other associated neurological symptoms. Neuroimaging is usually performed to...

This is a retrospective observational study, in which we reviewed the clinical history of patients with binocular diplopia attended in a tertiary referral center, who received an urgent CT-scan, over a period of 2 years (2016-2017). The patients were divided into three main cohorts depending on the affected nerve (3rd, 4th and 6th). We also determined if the patients complained of isolated binocular diplopia or referred diplopia-plus symptoms. Diplopia-plus was defined as a presence of diplopia and other neurological or ophthalmological symptoms or signs (e.g....

- 174 patients were included. There were 72 females (41%) and 102 males (59%), the mean age was 63 (range 19 to 92). - 20 patients (11%) were clinically diagnosed with isolated 3rd nerve palsy, 12 patients (7%) with isolated 4th nerve palsy, and 42 patients (24%) with isolated 6th nerve palsy. The remaining 100 patients (57%) had a clinical diagnosis of multiple cranial nerve palsies or an unclear clinical diagnosis. - Only 9% (n=15) of all CT scans performed in patients with binocular diplopia...

Binocular diplopia is a frequent symptom in a patient with neurological disorder, being the 3rd, 4th and 6th cranial nerves impairment the main etiology to consider. The most frequent cause of isolated cranial mononeuropathies in patients over 50-years-old, with CRF and without any other neurological or ophthalmological symptom is microvascular ischemia, being CT-scan in these cases normal. There are some criteria for performing neuroimaging in patients with binocular diplopia, such as first manifestation in younger than 50-year-old, history of neoplasia, paralysis of the 3rd cranial...

Author Information: Ewa J. Maciag – Department of Neuroradiology and MR-Unit, Vall d'Hebron Research Institute (VHIR), University Hospital Vall d’Hebron (Universitat Autònoma de Barcelona), Barcelona/Spain Santiago Ortiz-Perez – Ophthalmology Department, Oculoplastic, Lacrimal and Orbital Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona/Spain Bernardo Sanchez-Dalmau - OphthalmologyDepartment, Neuro-Ophthalmology Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona/Spain Alex Rovira-Cañellas - Department of Neuroradiology and MR-Unit, Vall d'Hebron Research Institute (VHIR), University Hospital Vall d’Hebron (Universitat Autònoma de Barcelona), Barcelona/Spain

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