Diplopia - Revision history

Neil.m.young: /* Evaluation */

2021-05-07T19:27:49Z

Evaluation

@@ Línea 82: / Línea 82: @@
 **[[LP]] if concern for [[meningitis]]
 **Metabolic workup to rule out diabetes or cause of mononeuropathy
 ==Management==

2020-09-26T16:21:00Z

← Revisión anterior		Revisión del 16:21 26 sep 2020
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	==Background==		==Background==
	[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]		[[File:Extraocular muscle actions and innervation.png\|thumb\|Eye movements by extra-ocular muscles and cranial nerve innervation]]
	[[File:Capture2.PNG\|thumbnail]]		[[File:Capture2.PNG\|thumbnail\|Right eye]]
	===Monocular Diplopia===		===Monocular Diplopia===
	*Double vision that persists when one eye is closed		*Double vision that persists when one eye is closed

2019-11-07T20:18:48Z

Binocular

← Revisión anterior		Revisión del 20:18 7 nov 2019
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	*[[CN III palsy\|Third nerve palsy]]: eye is down and out		*[[CN III palsy\|Third nerve palsy]]: eye is down and out
	**Always needs [[CT head\|CTH]]/CTA to rule out [[Posterior Communicating Artery (PCOM) Aneurysm\|aneurysm given that nerve runs under PCA		**Always needs [[CT head\|CTH]]/CTA to rule out [[Posterior Communicating Artery (PCOM) Aneurysm\|aneurysm given that nerve runs under PCA
	*[[trochlear nerve palsy\|Fourth nerve palsy]]		*[[trochlear nerve palsy\|Fourth nerve palsy]]: head tilt down and away from side of lesion
	**These are tough to catch and can be referred to ~~optho outpt~~ for prisms		**These are tough to catch and can be referred to ophtho outpatient for prisms
	**No imaging needed unless other deficits present		**No imaging needed unless other deficits present
	*[[abducens nerve palsy\|Sixth nerve palsy]]: eye can't track laterally		*[[abducens nerve palsy\|Sixth nerve palsy]]: eye can't track laterally

2019-10-06T21:46:41Z

Clinical Features

← Revisión anterior		Revisión del 21:46 6 oct 2019
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	===Exam===		===Exam===
	*Determine monocular vs binocular		*Determine monocular vs binocular
	*Evaluate for visual field ~~defect~~		*Evaluate for [[visual field defects]]
	*Evaluate visual acuity		*Evaluate [[vision loss\|visual acuity]]
	*Assess cranial nerves		*Assess [[cranial nerves]]
	**Multiple [[cranial nerve palsies\|cranial nerve involvement]] suggests an intracranial process or cavernous sinus involvement		**Multiple [[cranial nerve palsies\|cranial nerve involvement]] suggests an intracranial process or cavernous sinus involvement
	*Check extraocular muscle function		*Check extraocular muscle function

2019-10-02T00:45:45Z

References

2019-10-02T00:45:32Z

Binocular

← Revisión anterior		Revisión del 00:45 2 oct 2019
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	**MRV or CTV to eval for [[cavernous sinus thrombosis]]		**MRV or CTV to eval for [[cavernous sinus thrombosis]]
	**CT orbits w/ contrast to eval for orbital apex syndrome (like CST above, but with CN II involvement)		**CT orbits w/ contrast to eval for orbital apex syndrome (like CST above, but with CN II involvement)
	**MRI + DWI to if concern for [[CVA]]		**[[Brain MRI\|MRI]] + DWI to if concern for [[CVA]]
	**MRI ± MRA if unable to classify intracranial process on initial contrast CT with contrast		**[[Brain MRI\|MRI]] ± MRA if unable to classify intracranial process on initial contrast CT with contrast
	**MRI if concerned for [[MS]]		**[[Brain MRI\|MRI]] if concerned for [[MS]]
	**[[LP]] if concern for [[meningitis]]		**[[LP]] if concern for [[meningitis]]
	**Metabolic workup to rule out diabetes or cause of mononeuropathy		**Metabolic workup to rule out diabetes or cause of mononeuropathy

2019-09-28T18:38:35Z

Binocular

← Revisión anterior		Revisión del 18:38 28 sep 2019
Línea 64:		Línea 64:

	===Binocular===		===Binocular===
	*[[~~CNIII~~ palsy\|Third nerve palsy]]: eye is down and out		*[[CN III palsy\|Third nerve palsy]]: eye is down and out
	**Always needs [[CT head\|CTH]]/CTA to rule out [[Posterior Communicating Artery (PCOM) Aneurysm\|aneurysm given that nerve runs under PCA		**Always needs [[CT head\|CTH]]/CTA to rule out [[Posterior Communicating Artery (PCOM) Aneurysm\|aneurysm given that nerve runs under PCA
	*[[trochlear nerve palsy\|Fourth nerve palsy]]		*[[trochlear nerve palsy\|Fourth nerve palsy]]

2019-09-28T18:38:21Z

2018-12-07T07:32:53Z

Binocular

← Revisión anterior		Revisión del 07:32 7 dic 2018
Línea 67:		Línea 67:

	===Binocular===		===Binocular===
	*~~CT brain~~ with and without contrast ± CTA neck to rule out dissection and intracranial mass		*Third nerve palsy: eye is down and out
	*MRI + DWI to if concern for CVA		**Always needs CTH/CTA to r/o aneurysm given that nerve runs under PCA
	*~~MRI±MRA~~ if unable to classify intracranial process on initial contrast CT with contrast		*Fourth nerve palsy
	*MRI if concerned for MS.		**These are tough to catch and can be referred to optho outpt for prisms
			**No imaging needed unless other deficits present
			*Sixth nerve palsy: eye can't track laterally
			**Children need imaging to r/o tumor
			**In > 50, m/l ischemic and can get MRI outpt or just watch, assuming no papilledema as it can cause isolated CN VI palsy
			**If other nerves/deficits noted, consider MRI and further wu

			*Other imaging studies also include:
			**CTH with and without contrast ± CTA neck to rule out dissection and intracranial mass
			**MRV or CTV to eval for cavernous sinus thrombosis
			**CT orbits w/ contrast to eval for orbital apex syndrome (like CST above, but with CN II involvement)
			**MRI + DWI to if concern for CVA
			**MRI ± MRA if unable to classify intracranial process on initial contrast CT with contrast
			**MRI if concerned for MS

	==Management==		==Management==

2016-07-22T01:54:30Z

Text replacement - "==Diagnosis==" to "==Evaluation=="