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. 2021 May 4;8(5):002509.
doi: 10.12890/2021_002509. eCollection 2021.

Monocular Diplopia in Idiopathic Intracranial Hypertension: A Case Report and Literature Review

Gianluigi R Palmieri  1 , Mattia Sansone  1 , Roberto De Simone  1 , Marcello Moccia  1
Affiliations

Monocular Diplopia in Idiopathic Intracranial Hypertension: A Case Report and Literature Review

Gianluigi R Palmieri et al. Eur J Case Rep Intern Med. .

Abstract

Background: Diplopia is the double vision of a single object, and can be binocular or monocular. Binocular diplopia is caused by the misalignment of the visual axes, with images falling on the fovea of the fixating eye and on the extra-foveal retina of the non-fixating eye, as a consequence of both neurological (i.e., oculomotor nerve palsies, ocular myopathies, neuromuscular junction disorders) and ophthalmic disorders (i.e., decompensation of a pre-existing strabismus). In contrast, monocular diplopia is generally explained by intraocular pathology (i.e., refractive errors, ocular media abnormalities, dry eyes), causing the image of a single object to fall, at the same time, on the fovea and on the extra-foveal retina of the same eye.

Methods: We report the case of a 22-year-old woman presenting with acute-onset monocular diplopia.

Results: The diagnosis of idiopathic intracranial hypertension (IIH) was based on the presence of papilloedema and elevated cerebrospinal fluid (CSF) pressure. Monocular diplopia resolved after CSF subtraction.

Conclusions: We describe a case of monocular diplopia as a presenting symptom of IIH, and discuss diagnostic issues of this possibly underestimated symptom in neurology clinical practice. Careful ophthalmic and neuro-ophthalmic examination can identify clinical features of diplopia, and drive diagnosis and treatment.

Learning points: Monocular diplopia is mostly an ophthalmological condition but can occur in a number of neurological diseases.Idiopathic intracranial hypertension can present with monocular diplopia.Differential diagnoses of diplopia in neurology and ophthalmology settings need to account for headache disorders.

Keywords: Idiopathic intracranial hypertension; diplopia; monocular diplopia; papilloedema.

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Conflict of interest statement

Conflicts of Interests: The authors declare there are no competing interests.

Figures

Figure 1
Figure 1
Brain MRI. On brain MRI, we found flattening of the left posterior globe (arrow) (a), empty sella (maximum pituitary gland height on the midsagittal T2w images was reduced to 3.74 mm, with a suggested cut-off of 4.80 mm) (b), and optic nerve sheath enlargement (maximum diameters of the optic nerve sheath on coronal T2w images were increased to 7.43 mm on the left and 6.60 mm on the right, with a suggested cut-off of 5.60 mm) (c). Neither dural venous sinus stenosis or parenchymal abnormalities were found
See this image and copyright information in PMC

References

    1. Danchaivijitr C, Kennard C. Diplopia and eye movement disorders. Neurol Pract. 2004;75(4):iv24–iv31. - PMC - PubMed
    1. Comer RM, Dawson E, Plant G, Acheson JF, Lee JP. Causes and outcomes for patients presenting with diplopia to an eye casualty department. Eye. 2007;21(3):413–418. - PubMed
    1. Morris RJ. Double vision as a presenting symptom in an ophthalmic casualty department. Eye. 1991;5(1):124–129. - PubMed
    1. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81(13):1159–1165. - PubMed
    1. Hoffmann J, Huppertz HJ, Schmidt C, Kunte H, Harms L, Klingebiel R, et al. Morphometric and volumetric MRI changes in idiopathic intracranial hypertension. Cephalalgia. 2013;33(13):1075–1084. - PubMed