Son Yubin, Suh Hie Bum, Choi Hee-Young, Cabrera Michelle T, Jeon Hyeshin
Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Front Neurol. 2024 Nov 27;15:1470805. doi: 10.3389/fneur.2024.1470805. eCollection 2024.
This study aimed to investigate the clinical factors that predict abnormal radiographic findings in adults with acute onset binocular diplopia.
Medical records of consecutive patients aged >20 years who presented with acute binocular diplopia were retrospectively reviewed. Patients were divided into positive and negative groups according to radiographic findings. Demographic and clinical characteristics were compared. The risk factors for positive radiographic findings were investigated, and the area under the receiver operating characteristic curve (AUC) was calculated.
Among 242 patients (145 males and 97 females), 44 (18.2%) were in the positive group and 198 (81.8%) in the negative group. Patients in the positive group were older ( = 0.005) and had more vasculopathic risk factors ( = 0.038). Severe duction limitation (>50% reduction in motility) was present in 90.9% of patients in the positive group and 56.1% in the negative group ( < 0.001). Abnormal slit lamp findings and pupillary exam abnormalities were also more frequent in the positive group than in the negative group ( = 0.027 and = 0.036, respectively). Older age, higher intraocular pressure, abnormal slit-lamp findings, exophthalmos, and duction limitation were identified as risk factors for positive radiographic findings. A predictive model generated an AUC of 0.772.
Older age and vasculopathic risk factors were associated with underlying radiographic pathologies, supporting the recommendation that neuroimaging should not be delayed in those patients. Careful ophthalmic evaluations may guide diagnosis and decision-making for immediate neuroimaging in cases of diplopia.
本研究旨在调查预测急性起病的双眼复视成人患者影像学检查异常结果的临床因素。
回顾性分析连续就诊的年龄>20岁的急性双眼复视患者的病历。根据影像学检查结果将患者分为阳性组和阴性组。比较两组的人口统计学和临床特征。研究影像学检查阳性结果的危险因素，并计算受试者操作特征曲线（AUC）下面积。
在242例患者（145例男性和97例女性）中，阳性组44例（18.2%），阴性组198例（81.8%）。阳性组患者年龄较大（P = 0.005）且血管病变危险因素较多（P = 0.038）。阳性组90.9%的患者存在严重的眼球运动受限（运动减少>50%），阴性组为56.1%（P<0.001）。阳性组裂隙灯检查异常和瞳孔检查异常也比阴性组更常见（分别为P = 0.027和P = 0.036）。年龄较大、眼压升高、裂隙灯检查异常、眼球突出和眼球运动受限被确定为影像学检查阳性结果的危险因素。预测模型的AUC为0.772。
年龄较大和血管病变危险因素与潜在的影像学病变相关，支持对这些患者不应延迟神经影像学检查的建议。仔细的眼科评估可能会指导复视病例中立即进行神经影像学检查的诊断和决策。
