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1. CRACKCast E021 – Diplopia

CRACKCast E021 – Diplopia CRACKCast E021 - Diplopia - CanadiEM CRACKCast E021 – Diplopia In , by Adam Thomas January 5, 2017 This episode of CRACKCast covers Rosen’s Emergency Medicine, Chapter 021 – Diplopia. Here the podcast reviews how to risk stratify diplopia and when to be most concerned for this uncommon chief complaint. Shownotes – Rosen’s in Perspective Diplopia is uncommon presentation to the ED, representing 1.4% of eye emergencies; however, it can be extremely debilitating (...) for patients when it does occur. Diplopia can be: Monocular (15%) – persists in one eye even if the other eye is closed Binocular (85%) – resolves when either eye is closed Monocular = distortion with the light path through the eye (typically an eye issue) Binocular = pathology can exist in multiple locations, including: Ocular Ocular muscle Cranial nerves (CN VI palsy a very common cause of diplopia) Upper versus lower neuron disease Ocular centre dysfunction in CNS Brainstem 1) List the differential

2017 CandiEM

2. Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough (PubMed)

Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough Midline structural defects in the neural axis can give rise to neuro-ophthalmic symptoms. We report a rare case of keyhole aqueduct syndrome presenting after two years of severe cough due to gastroesophageal reflux disease.A 58-year-old woman with a 2-year history of daily, severe cough presented to the neuro-ophthalmology clinic with progressive diplopia and oscillopsia. Examination (...) in the ventral midbrain communicating with the cerebral aqueduct, consistent with keyhole aqueduct syndrome. Her nystagmus and diplopia improved with oral acetazolamide treatment, at high doses of 2500-3000 mg per day.We report the first case of midbrain keyhole aqueduct syndrome with ocular motor and other neuro-ophthalmic manifestations associated with severe cough. Although her cough was effectively treated and intracranial pressure measurement was normal, her ophthalmic symptoms continued to progress

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2018 American journal of ophthalmology case reports

3. Sudden Diplopia at Pediatric Emergency Department: A Case of Gradenigo Syndrome in a Child. (PubMed)

Sudden Diplopia at Pediatric Emergency Department: A Case of Gradenigo Syndrome in a Child. Otitis media, facial pain in trigeminal region, and ipsilateral abducens nerve palsy clinically define Gradenigo syndrome, a rare but serious complication of suppurative middle ear infection. Radiological investigation is required to confirm petrous apex involvement and to exclude further consequences as sinus thrombosis, meningitis, and intracranial abscess.We report the case of an 8-year-old child

2019 Pediatric Emergency Care

4. A 53-Year-Old Man Presenting With Diplopia and Cavitary Lung Nodules. (PubMed)

A 53-Year-Old Man Presenting With Diplopia and Cavitary Lung Nodules. A 53-year-old Chinese man presented with 1 week of worsening diplopia and left-sided facial droop. His symptoms developed during a readmission for elective drainage and curettage of a perianal abscess that recurred despite drainage 2 weeks before. He denied having other neurologic symptoms, and did not report any cough, sputum production, night sweats, or fever. He was a lifelong nonsmoker with a history of polymyositis

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2019 Chest

5. A Man with Diplopia and Polyuria

A Man with Diplopia and Polyuria Rotation Prep | NEJM Resident 360 Social Login Email Login Log in via Email Create Your Account We will not share your email with anyone. Password must be at least 8 characters. Show or Hide the password you are typing. Request to Join has invited you to join this group Your browser does not support video tags Welcome! NEJM Resident 360 helps you prepare for your next rotation quickly and efficiently, provides support for coping with the pressures of resident

2016 Now@NEJM

6. Approach to a Patient with Diplopia in the Emergency Department. (PubMed)

Approach to a Patient with Diplopia in the Emergency Department. Diplopia can be the result of benign or life-threatening etiologies. It is imperative for the emergency physician to be proficient at assessing diplopia and recognize when urgent referral or neuroimaging is required.The first part of this review highlights a simple framework to arrive at the appropriate disposition of diplopic patients presenting to the emergency department (ED). The second part of this review provides more detail (...) and further management strategies.ED strategies for assessment of diplopia are discussed. Management strategies, such as when to image, what modality of imaging to use, and urgency of referral, are discussed in detail.Unenhanced plain computed tomography (CT) of the head or orbits is largely not useful in the work-up of diplopia. Magnetic resonance imaging is preferred for ocular motor nerve palsies. Due to limited resources in the ED, patients with isolated fourth and sixth nerve palsies with the absence

2018 Journal of Emergency Medicine

7. Resolution of Diplopia in Late Repair of Enophthalmos Following Facial Trauma.

Resolution of Diplopia in Late Repair of Enophthalmos Following Facial Trauma. Posttraumatic enophthalmos due to isolated or complex orbital fractures can contribute to diplopia. Current evidence recommends early repair. However, little is known about the outcome of enophthalmos correction when repair occurs beyond 30 days after trauma. In this systematic review, the authors aim to evaluate the current evidence on functional outcomes after delayed repair of posttraumatic enophthalmos.Two (...) independent assessors undertook a systematic review of the literature using multiple databases. The authors' inclusion criteria identified studies involving patients at least 14 years of age who had surgical correction of persistent enophthalmos 30 days after initial trauma. Each eligible paper was included after critical appraisal using validated guidelines. Data on preoperative and postoperative enophthalmos and diplopia in each study was extracted. The pattern of fracture was also noted.The authors

2018 The Journal of craniofacial surgery

8. Developed diplopia due to a pituitary macroadenoma during pregnancy (PubMed)

Developed diplopia due to a pituitary macroadenoma during pregnancy Physiologic pituitary enlargement is common during normal pregnancy. However, symptoms such as diplopia, blurred vision and headache resulting from physiologic pituitary enlargement are very rare during pregnancy. A 43-year-old woman complained of sudden headache and left eye ptosis at 36th weeks of gestation. An magnetic resonance imaging (MRI) demonstrated the pituitary enlargement and a macroadenoma without a compressing

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2018 The Pan African medical journal

9. Diplopia: A Rare Manifestation of Neuroborreliosis (PubMed)

Diplopia: A Rare Manifestation of Neuroborreliosis Early disseminated Lyme disease typically presents with cardiac, rheumatologic, or neurologic symptoms. Though uncommon, Borrelia burgdorferi can invade the central nervous system and cause neuroborreliosis. In these patients, facial palsy, headache, and stiffness of the neck are the most common presenting symptoms. Our case describes a patient with oculomotor nerve palsy manifesting as double vision as the initial presentation

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2018 Case reports in neurological medicine

10. Impact of a Magnetic Resonance Imaging (MRI) Scanner Exclusively Dedicated to Emergency in the Clinical Management of Patients Presenting With Diplopia or Dizziness

Impact of a Magnetic Resonance Imaging (MRI) Scanner Exclusively Dedicated to Emergency in the Clinical Management of Patients Presenting With Diplopia or Dizziness Impact of a Magnetic Resonance Imaging (MRI) Scanner Exclusively Dedicated to Emergency in the Clinical Management of Patients Presenting With Diplopia or Dizziness - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x (...) × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Impact of a Magnetic Resonance Imaging (MRI) Scanner Exclusively Dedicated to Emergency in the Clinical Management of Patients Presenting With Diplopia or Dizziness (IRM-DU) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been

2018 Clinical Trials

11. Epidural blood patch treatment of diplopia that developed after headache resolution in a patient with spontaneous intracranial hypotension (PubMed)

Epidural blood patch treatment of diplopia that developed after headache resolution in a patient with spontaneous intracranial hypotension Sudden headache onset may rarely be caused by spontaneous intracranial hypotension (SIH). Other associated symptoms in patients with SIH are nausea, vomiting, vertigo, hearing alteration, and visual disturbance. This case report describes a 43-year-old female diagnosed with SIH who developed diplopia after resolution of an abrupt-onset headache, which (...) was managed with conservative treatments, including bed rest and hydration. She was also diagnosed with secondary right sixth cranial nerve palsy. Although conservative management relieved her headache, the diplopia was not fully relieved. Application of an autologous epidural blood patch successfully relieved her diplopia, even after 14 days from the onset of visual impairment.

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2018 Journal of Dental Anesthesia and Pain Medicine

12. Motility Changes and Diplopia After Baerveldt Glaucoma Drainage Device Implantation or After Trabeculectomy (PubMed)

Motility Changes and Diplopia After Baerveldt Glaucoma Drainage Device Implantation or After Trabeculectomy The purpose of this study was to quantify any diplopia and motility changes after the implantation of a Baerveldt glaucoma implant (BGI) or after trabeculectomy (TE).We analyzed 51 patients with a BGI and 52 patients with a TE from a prospective cohort study. To quantify any diplopia, we asked patients about the presence of diplopia at 1 year after surgery. To quantify any ocular motility (...) changes, we measured ductions in eight gaze directions, the patients' ocular alignment and their fusion range before and 1 year after surgery.In the BGI group, 14 patients (28%) experienced diplopia compared with one patient (2%) in the TE group (P < 0.001). Duction changes were more commonly observed in the BGI group (35%) than in the TE group (19%). In the BGI group, ductions were mostly restricted in elevation (13%; P < 0.001), in abduction (13%), in elevation in 25° adduction (13%; P = 0.044

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2018 Translational vision science & technology

13. Nonsurgical treatment of diplopia. (PubMed)

Nonsurgical treatment of diplopia. As the population ages, the number of patients presenting to ophthalmologists with complaints of double vision is increasing.Diplopia is known to occur for optical, neuroophthalmological, strabismological and even iatrogenic reasons following various ophthalmic surgical procedures. The mainstays of the nonsurgical treatment of diplopia including no treatment, partial or total occlusion, press-on or ground in prisms and vergence exercises (to increase fusional (...) vergence amplitudes) have been utilized for some time. Although a review of the literature demonstrates that very little has been published on this topic in recent years, subtle treatment variations have evolved.The ability to successfully manage patients' diplopia symptoms remains important to decrease the risk of patient injuries, as well as maximize their independence and quality of life. These concerns are especially important as patients age.

2018 Current Opinion in Ophthalmology

14. Spelunking Meckel Cave: A 31-Year-Old With Diplopia and Loss of Taste and Smell. (PubMed)

Spelunking Meckel Cave: A 31-Year-Old With Diplopia and Loss of Taste and Smell. A 31-year-old woman presented to the ED with a loss of taste and smell of 2 months' duration and a frontal headache, bilateral facial numbness, photophobia, and horizontal diplopia that was worse with far vision of 2 weeks' duration. A review of systems revealed mild nausea and decreased appetite without weight loss. She denied any cardiopulmonary symptoms, specifically no cough or shortness of breath. Her medical

2018 Chest

15. New Onset vs Resolution of Central-Peripheral Rivalry-Type Diplopia in Patients Undergoing Epiretinal Membrane Peeling. (PubMed)

New Onset vs Resolution of Central-Peripheral Rivalry-Type Diplopia in Patients Undergoing Epiretinal Membrane Peeling. The peeling of an epiretinal membrane (ERM) is commonly performed for poor visual acuity and/or metamorphopsia, but to our knowledge, its influence on central-peripheral rivalry (CPR)-type diplopia has not been rigorously studied.To evaluate the occurrence of either resolution or new-onset CPR-type diplopia in patients undergoing ERM peeling.This prospective cohort study (...) was conducted from July 2014 to April 2018 at a tertiary referral medical center and included 33 adults with ERM who were undergoing peeling surgery with planned preoperative to postoperative analysis.A standardized diplopia questionnaire completed before undergoing and 6 months following ERM peeling.For patients with CPR-type diplopia before ERM peeling (rated "sometimes" or more for distance straight ahead or reading using the diplopia questionnaire), we calculated the proportion with resolution

2018 JAMA ophthalmology

16. The impact of strabismus on quality of life in adults with and without diplopia: a systematic review. (PubMed)

The impact of strabismus on quality of life in adults with and without diplopia: a systematic review. Strabismus affects approximately 4% of the adult population and can cause substantial physical disturbance and changes to appearance. This article aims to examine the impact of strabismus in adults both with and without diplopia, focusing primarily on quality of life (QoL). We highlight the value of measuring QoL, assess the ways in which it can be measured, and the impact the disease, diplopia (...) , and surgery have on the patient. QoL differs for strabismus patients based on their diplopia status. Patients with diplopia tend to have more concerns relating to functional QoL, whereas patients without diplopia have primarily psychosocial concerns. Two diplopia-specific questionnaires have been designed to assess QoL and the perceived severity of symptoms. Further research is needed to identify the variables which influence QoL so that appropriate support can be given to all patients with strabismus

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2017 Survey of Ophthalmology

17. Diplopia Following Short Treatment for Moderate Amblyopia. (PubMed)

Diplopia Following Short Treatment for Moderate Amblyopia. A case of an autistic child, aged 8 years, who reported binocular diplopia following just 2 hours total occlusion per day for 6 weeks for strabismic/anisometropic amblyopia is reported. There was a history of known long-standing reduced uniocular acuity without treatment. Pretreatment Sbisa bar assessment suggested moderate suppression. The diplopia was treated over 6 months including occluding the amblyopic eye and gradually reducing (...) the density of the occluder until fixation with the nonamblyopic eye could be maintained and diplopia ignored. Possible contributing factors are discussed.

2017 Strabismus

18. Extra-ocular movement restriction and diplopia following orbital fracture repair. (PubMed)

Extra-ocular movement restriction and diplopia following orbital fracture repair. To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used.A chart review was conducted identifying all patients >18years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular (...) without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia.Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures

2017 American Journal of Otolaryngology

19. An ethmoid mucocele causing diplopia: A case report. (PubMed)

An ethmoid mucocele causing diplopia: A case report. Mucocele is a disease lined primarily by epithelium, and occurs mainly when the sinus ostium is obstructed.We report a case of a 37-year-old man who presented with painless proptosis of the right eye and diplopia.The preoperative finding was mucocele of the ethmoid sinus.We performed endoscopic sinus surgery, which included uncapping of the anterior and superior wall of the mucocele.The mucocele was treated safely and effectively without

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2017 Medicine

20. Prevalence and Associations of Central-Peripheral Rivalry-Type Diplopia in Patients With Epiretinal Membrane. (PubMed)

Prevalence and Associations of Central-Peripheral Rivalry-Type Diplopia in Patients With Epiretinal Membrane. The prevalence and clinical associations of patients with epiretinal membrane (ERM) who develop central-peripheral rivalry (CPR)–type diplopia are unknown.To determine the prevalence of CPR-type diplopia in retinal disease clinic patients with ERM and to determine clinical findings associated with CPR-type diplopia.A prospective cross-sectional study of 31 patients with ERM from retinal (...) disease clinics to determine the prevalence of CPR-type diplopia. A retrospective case cohort of 25 additional patients with ERM, selected from adult strabismus clinics, was added (total = 56) to determine clinical associations with CPR-type diplopia. All data were collected between June 2014 and November 2016; prospective cohort data were collected from June 2016 to November 2016.The presence of diplopia was determined by patient history and diplopia questionnaire responses. Visual acuity and ocular

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2017 JAMA ophthalmology

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