Differential Diagnosis for Vertical Diplopia and Unilateral Headache
- Single most likely diagnosis
- Fourth Cranial Nerve (Trochlear Nerve) Palsy: This condition often presents with vertical diplopia due to the nerve's control over the superior oblique muscle, which is responsible for rotating the eye downward. Unilateral headache can accompany this condition, especially if it's caused by a microvascular issue or a tense headache syndrome.
- Other Likely diagnoses
- Cluster Headache: Known for causing severe, unilateral headaches, cluster headaches can also lead to diplopia due to the involvement of cranial nerves during an attack.
- Migraine with Ocular Symptoms: Some migraines can cause transient diplopia, including vertical, and are often accompanied by unilateral headache.
- Superior Oblique Myokymia: This rare condition causes intermittent, involuntary contractions of the superior oblique muscle, leading to vertical diplopia and can be associated with headache.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aneurysm or Arteriovenous Malformation (AVM): Although less common, aneurysms or AVMs pressing on cranial nerves can cause diplopia and headache. Missing these diagnoses could be catastrophic.
- Giant Cell Arteritis: This condition can cause headache and, if it involves the nerves controlling eye movement, could lead to diplopia. It's a medical emergency due to the risk of vision loss.
- Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause diplopia and headache due to the involvement of cranial nerves passing through the cavernous sinus.
- Rare diagnoses
- Skull Base Tumors: Tumors in this area can compress cranial nerves, leading to diplopia and headache.
- Demyelinating Diseases (e.g., Multiple Sclerosis): These conditions can cause a wide range of neurological symptoms, including diplopia and headache, due to the involvement of various parts of the central nervous system.
- Tolosa-Hunt Syndrome: A rare condition characterized by headache and diplopia due to nonspecific inflammation of the cavernous sinus or superior orbital fissure.