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Approach to Diplopia

机译：探讨公报

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purpose of review: "Double vision" is a commonly encountered concern in neurologic practice; the experience of diplopia is always sudden and is frequently a cause of great apprehension and potential disability for patients. Moreover, while some causes of diplopia are benign, others require immediate recognition, a focused diagnostic evaluation, and appropriate treatment to prevent vision- and life-threatening outcomes. A logical, easy-to-follow approach to the clinical evaluation of patients with diplopia is helpful in ensuring accurate localization, a comprehensive differential diagnosis, and optimal patient care. This article provides a foundation for formulating an approach to the patient with diplopia and includes practical examples of developing the differential diagnosis, effectively using confirmatory examination techniques, determining an appropriate diagnostic strategy, and (where applicable) providing effective treatment. recent findings: Recent population-based analyses have determined that diplopia is a common presentation in both ambulatory and emergency department settings, with 850,000 such visits occurring annually. For patients presenting to an outpatient facility, diagnoses are rarely serious. However, potentially life-threatening causes (predominantly stroke or transient ischemic attack) can be encountered. In patients presenting with diplopia related to isolated cranial nerve palsy, immediate neuroimaging can often be avoided if an appropriate history and examination are used to exclude worrisome etiologies. summary: Binocular diplopia is most often due to a neurologic cause. The onset of true "double vision" is debilitating for most patients and commonly prompts immediate access to health care services as a consequence of functional impairment and concern for worrisome underlying causes. Although patients may seek initial evaluation through the emergency department or from their primary care/ophthalmic provider, elimination of an ocular cause will not infrequently result in the patient being referred for neurologic consultation. A logical, localization-driven, and evidence-based approach is the most effective way to arrive at the correct diagnosis and provide the best outcome for the patient.
机译：审查目的：“双重视野”是神经系统实践中常见的关注;复证的经验总是突然的，往往是患者毫不忧虑和潜在残疾的原因。此外，虽然复制品的一些原因是良性的，但其他人需要立即识别，一个重点的诊断评估，以及适当的治疗，以防止视力和危及生命的结果。逻辑，易于遵循的临床评估方法对复制症患者的临床评估有助于确保准确的本地化，综合鉴别诊断和最佳患者护理。本文为配制复制患者的方法提供了基础，包括开发鉴别诊断的实际例子，有效地使用确认检查技术，确定适当的诊断策略，以及提供有效治疗的（如适用）。结果对于呈现给门诊设施的患者，诊断很少严重。然而，可能会遇到潜在的危及生命的原因（主要是中风或短暂的缺血性攻击）。在患有与孤立的颅神经麻痹相关的复源性的患者中，如果使用适当的历史和检查用于排除令人担忧的病因，通常可以避免立即神经影像动物。摘要：双目复视往往是由于神经系统原因。真正的“双重愿景”的发作是对大多数患者的衰弱，并且通常会提示由于功能损伤和对令人担忧的潜在原因而关注的问题而立即获得医疗服务。虽然患者可能会通过急诊部门或其初级保健/眼科提供者寻求初步评估，但消除眼部原因不会少甚至导致患者被提及的神经系统咨询。逻辑，本地化驱动和基于证据的方法是最有效的方式到达正确的诊断，并为患者提供最佳结果。

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