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Doctor, I'm Seeing Two of Everything

Acute diplopia is a rare chief complaint with a broad differential diagnosis; key historical and physical characteristics aid with emergency management. This case report discusses the important findings, imaging, and multidisciplinary interaction between emergency medicine, ophthalmology, and neurol...

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Detalles Bibliográficos
Autores principales: Davis, Alex, Lloyd, Christopher M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008758/
https://www.ncbi.nlm.nih.gov/pubmed/32064184
http://dx.doi.org/10.7759/cureus.6602
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author Davis, Alex
Lloyd, Christopher M
author_facet Davis, Alex
Lloyd, Christopher M
author_sort Davis, Alex
collection PubMed
description Acute diplopia is a rare chief complaint with a broad differential diagnosis; key historical and physical characteristics aid with emergency management. This case report discusses the important findings, imaging, and multidisciplinary interaction between emergency medicine, ophthalmology, and neurology regarding the approach to addressing acute painless vertical diplopia. A 51-year-old male presented to the emergency department (ED), reporting that he was seeing 'two of everything,' since awakening. Although the patient had a history of ischemic stroke, he had never experienced this sensation of diplopia. His ED workup was essentially unremarkable; he was admitted for evaluation of the possibilities of a fourth cranial nerve (CN IV) palsy, acute Parinaud syndrome, or ischemic stroke. Ultimately the patient was sent home one day after admission with the diagnosis of CN IV neuropathy. Highlighted is an approach to undifferentiated diplopia with an included discussion of the pathophysiology of a CN IV palsy and Parinaud syndrome. Understanding basic pathophysiology and anatomy allows for a proper history, physical exam, and appropriate consultation. With these tools, emergency physicians can improve their approach to patients with acute diplopia when arriving at the ED.
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spelling pubmed-70087582020-02-15 Doctor, I'm Seeing Two of Everything Davis, Alex Lloyd, Christopher M Cureus Endocrinology/Diabetes/Metabolism Acute diplopia is a rare chief complaint with a broad differential diagnosis; key historical and physical characteristics aid with emergency management. This case report discusses the important findings, imaging, and multidisciplinary interaction between emergency medicine, ophthalmology, and neurology regarding the approach to addressing acute painless vertical diplopia. A 51-year-old male presented to the emergency department (ED), reporting that he was seeing 'two of everything,' since awakening. Although the patient had a history of ischemic stroke, he had never experienced this sensation of diplopia. His ED workup was essentially unremarkable; he was admitted for evaluation of the possibilities of a fourth cranial nerve (CN IV) palsy, acute Parinaud syndrome, or ischemic stroke. Ultimately the patient was sent home one day after admission with the diagnosis of CN IV neuropathy. Highlighted is an approach to undifferentiated diplopia with an included discussion of the pathophysiology of a CN IV palsy and Parinaud syndrome. Understanding basic pathophysiology and anatomy allows for a proper history, physical exam, and appropriate consultation. With these tools, emergency physicians can improve their approach to patients with acute diplopia when arriving at the ED. Cureus 2020-01-08 /pmc/articles/PMC7008758/ /pubmed/32064184 http://dx.doi.org/10.7759/cureus.6602 Text en Copyright © 2020, Davis et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Endocrinology/Diabetes/Metabolism
Davis, Alex
Lloyd, Christopher M
Doctor, I'm Seeing Two of Everything
title Doctor, I'm Seeing Two of Everything
title_full Doctor, I'm Seeing Two of Everything
title_fullStr Doctor, I'm Seeing Two of Everything
title_full_unstemmed Doctor, I'm Seeing Two of Everything
title_short Doctor, I'm Seeing Two of Everything
title_sort doctor, i'm seeing two of everything
topic Endocrinology/Diabetes/Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008758/
https://www.ncbi.nlm.nih.gov/pubmed/32064184
http://dx.doi.org/10.7759/cureus.6602
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