Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: July 29, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis for Acute Diplopia with Mild to Moderate T2 Hyperintense Periventricular and Subcortical Lesions

  • Single Most Likely Diagnosis
    • Multiple Sclerosis (MS): This is a leading consideration due to the presence of periventricular and subcortical lesions on MRI, which are characteristic of MS. The acute onset of diplopia can be a presenting symptom of a relapse in MS.
  • Other Likely Diagnoses
    • Acute Disseminated Encephalomyelitis (ADEM): Although less common than MS, ADEM can present with similar MRI findings and acute neurological symptoms, including diplopia. It is often considered in the differential diagnosis, especially in patients without a prior history of MS.
    • Small Vessel Disease: This condition can cause subcortical and periventricular white matter lesions due to chronic small vessel ischemic changes. While it might not directly cause acute diplopia, it could contribute to the neurological presentation in conjunction with other factors.
  • Do Not Miss Diagnoses
    • CNS Vasculitis: This is a critical diagnosis not to miss due to its potential for severe morbidity and mortality if left untreated. CNS vasculitis can present with a wide range of neurological symptoms, including acute onset of diplopia, and can cause lesions visible on MRI.
    • CNS Lymphoma: Although rare, CNS lymphoma can present with periventricular and subcortical lesions and acute neurological symptoms. It requires prompt diagnosis and treatment to improve outcomes.
  • Rare Diagnoses
    • Progressive Multifocal Leukoencephalopathy (PML): This rare and often fatal viral disease caused by the JC virus affects the brain and leads to the destruction of the myelin sheath. It typically occurs in immunocompromised individuals and can present with subcortical and periventricular white matter lesions.
    • Susac Syndrome: A rare condition characterized by microangiopathic changes in the brain, retina, and cochlea, leading to a variety of symptoms including vision loss, hearing loss, and neurological deficits. It can present with lesions on MRI similar to those described.

Related Questions

What is the recommended treatment for patients with Lyme disease experiencing cardiovascular effects, such as Lyme carditis?
What are the treatment options for Covid-19?
What is the treatment for Bartholinosis (Bartholin gland infection)?
What is the clinical significance of elevated Alanine Transaminase (ALT) and mildly decreased estimated Glomerular Filtration Rate (e-GFR) in a patient?
What are the symptoms of overtreatment with Attention Deficit Hyperactivity Disorder (ADHD) medications such as Ritalin (methylphenidate) or Adderall (amphetamine and dextroamphetamine)?
What is the appropriate dosing of Adderall (amphetamine and dextroamphetamine) for adults with ADHD?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question