Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
IRCCS Neuromed, Pozzilli, IS, Italy.
Acta Neurol Scand. 2021 Jul;144(1):92-98. doi: 10.1111/ane.13425. Epub 2021 Mar 31.
To investigate the aetiology of acute-onset binocular diplopia (AOBD) in neurological units and identify the key diagnostic procedures in this setting.
Clinico-demographic data from patients hospitalized for AOBD from 2008 to 2019 were retrospectively reviewed. AOBD due to an underlying neurological disorder known to cause diplopia was addressed as secondary diplopia. Ophthalmoparesis plus was defined when subtle neurological signs/symptoms other than ophthalmoparesis were detected during neurological examination.
A total of 171 patients (mean age 57.6 years) were included in the study. A total of 89 subjects (52%) had an oculomotor disturbance consistent with sixth nerve palsy, and 42 (24.6%) showed multiple oculomotor nerve involvement. The most common cause of AOBD was presumed to be microvascular in 56 patients (32.7%), while a secondary aetiology was identified in 102 (59.6%). Ophthalmoparesis plus and multiple oculomotor nerve involvement significantly predicted a secondary aetiology in multivariable logistic regression analysis. Brain CT was never diagnostic in isolated ophthalmoparesis. A combination of neuroimaging examinations established AOBD diagnosis in 54.9% of subjects, whereas rachicentesis and neurophysiological examinations were found to be performant in the remaining cases.
AOBD may herald insidious neurological disease, and an extensive diagnostic workup is often needed to establish a diagnosis. Neurological examination was pivotal in identifying patients at higher risk of secondary aetiology. Even in cases of apparently benign presentation, a serious underlying disease cannot be excluded. Brain MRI was found to perform well in all clinical scenarios, and it should be always considered when managing AOBD.
调查神经内科急性发作性双眼复视（AOBD）的病因，并确定该情况下的关键诊断程序。
回顾性分析 2008 年至 2019 年因 AOBD 住院的患者的临床-人口统计学数据。已知会引起复视的潜在神经障碍引起的 AOBD 被视为继发性复视。如果在神经系统检查中发现除眼肌麻痹外还有其他细微的神经系统体征/症状，则定义为眼肌麻痹+。
共有 171 名患者（平均年龄 57.6 岁）纳入研究。共有 89 名患者（52%）存在与第六神经麻痹一致的眼运动障碍，42 名（24.6%）表现为多根动眼神经受累。56 名患者（32.7%）的 AOBD 最常见的病因被认为是微血管性，而 102 名患者（59.6%）则确定为继发性病因。多变量逻辑回归分析显示，眼肌麻痹+和多根动眼神经受累显著预测继发性病因。脑 CT 对孤立性眼肌麻痹从未具有诊断意义。神经影像学检查的组合确定了 54.9%患者的 AOBD 诊断，而脊穿刺和神经生理学检查在其余病例中表现良好。
AOBD 可能预示着隐匿性神经疾病，通常需要进行广泛的诊断性检查以确定诊断。神经系统检查对于识别具有继发性病因更高风险的患者至关重要。即使在表现看似良性的情况下，也不能排除潜在的严重疾病。脑 MRI 在所有临床情况下表现良好，在管理 AOBD 时应始终考虑。
