Differential Diagnosis for Red Flags Double Vision
- Single most likely diagnosis
- Multiple Cranial Neuropathies (e.g., due to Diabetes Mellitus): This condition often presents with double vision due to the involvement of cranial nerves III, IV, or VI, which control eye movements. Diabetes is a common cause and can lead to multiple cranial neuropathies, making it a likely diagnosis for double vision with red flags.
- Other Likely diagnoses
- Thyroid Ophthalmopathy: This condition can cause double vision due to the involvement of extraocular muscles and nerves. It is often associated with other symptoms like exophthalmos and eyelid retraction.
- Myasthenia Gravis: An autoimmune disorder that affects the neuromuscular junction, leading to fluctuating muscle weakness, including the muscles controlling eye movements, which can cause double vision.
- Stroke or Transient Ischemic Attack (TIA): Although less common as a primary cause of double vision, a stroke or TIA can affect the brainstem or cranial nerves, leading to diplopia.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aneurysm (e.g., Posterior Communicating Artery Aneurysm): An expanding aneurysm can compress cranial nerve III, leading to double vision, and is a medical emergency if it ruptures.
- Pituitary Apoplexy: A sudden hemorrhage or infarction of a pituitary tumor can compress surrounding structures, including cranial nerves, causing double vision among other symptoms.
- Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause double vision by affecting the cranial nerves passing through the cavernous sinus.
- Rare diagnoses
- Wernicke's Encephalopathy: A condition caused by thiamine deficiency, often seen in alcoholics, which can lead to ophthalmoplegia and double vision.
- Tolosa-Hunt Syndrome: A rare disorder characterized by inflammation of the cavernous sinus or superior orbital fissure, leading to painful ophthalmoplegia and double vision.
- Gradenigo's Syndrome: A rare condition caused by inflammation of the petrous apex, leading to a triad of symptoms including double vision due to abducens nerve palsy.