Type:
Educational Exhibit
Keywords:
Anatomy, Eyes, Head and neck, MR, Imaging sequences, Aneurysms, Haemorrhage, Ischaemia / Infarction
Authors:
A. Micolich Vergara, B. Beltrán Mármol, A. Gené Orriols, M. Saint-Gerons, J. M. Maiques
DOI:
10.26044/ecr2023/C-17378
Findings and procedure details
IMAGING ASSESMENT OF BINOCULAR DIPLOPIA
MRI is the recommendend imaging modality in the evaluation of patients with binocular diplopia because of its high image resolution in the assesment of the brainstem, subarachnoid spaces, cavernous sinus and orbital structures. It is critical to perform an MRI study in the following cases: new onset diplopia in patient less than 50 years old, presence of more than one neurologic symptom, symptom progression or history of cancer.
Optimal MRI protocol should include:
- axial T2w of brain and brainstem
- axial/coronal T1w of the orbit
- heavily weighted axial T2w of the cisternal segment
- axial/coronal T1w after gadolinium (Gd)
- DWI
- FLAIR
- MRI angiography (TOF)
DIFFERENTIALS ACCORDING TO TOPOGRAPHIC DIVISION
1) BRAINSTEM
- Vascular causes:
- ischemic injury: small or large strokes affecting the nuclear portion or brainstem courses
- hemorrhagic injury
- Tumoral causes
2) SUBARACHNOID SPACE (interpeduncular and prepontine cistern)
- Vascular aneurismatic causes (PCoA)
- Infectious diseases
- Traumatic
- Intracranial hypertension
3) CAVERNOUS SINUS
- Infectious diseases
- Invasive sellar masses
- Vascular aneurismatic causes (ICA)
4) SUPERIOR ORBITAL FISSURE
5) ORBIT
- Traumatic: orbital fractures
- Tumoral: orbital cavernous malformation
- Infectious disease (celullitis)
- Restrictive myopathies:
- Graves disease orbitopathy
- Fibrous dysplasia
- Inflammatory myopathies