The American journal of emergency medicine · 2025
Presentation, management and outcomes of patients with diplopia in the emergency department.
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Occelli Céline, Coffin Valentine, Raynaud Oliver, Vigneau Jean-François, Coisy Fabien, Marchetto Pauline, Bobbia Xavier
Аннотация
BACKGROUND: Diplopia is a reason for emergency department (ED) visits with both ophthalmological and neurological causes, some of which may require urgent therapeutic intervention. Epidemiological data on this symptom, particularly in the context of general EDs, remain scarce. This study aims to investigate the epidemiology, clinical characteristics, management strategies, and etiologies of diplopia in general EDs.
METHODS: We conducted a bicentric retrospective study of patients admitted for diplopia between January 2022 and December 2023 in the general EDs of two French university hospitals.
RESULTS: We included 788 patients admitted for diplopia, representing 0.2 % of all ED admissions. Binocular diplopia was predominant, accounting for 751 cases (95 %), with the most common etiologies being microangiopathies (250 cases, 33 %), strokes (140 cases, 19 %), and myasthenia gravis (36 cases, 5 %). Cardiovascular risk factor prevalence did not differ between monocular and binocular diplopia. Imaging was performed in 712 cases (90 %), including 694 cases (92 %) of binocular diplopia and 18 cases (48 %) of monocular diplopia. The imaging primarily consisted of magnetic resonance imaging in 550 cases (70 %), computed tomography in 283 cases (36 %), and both modalities in 121 cases (15 %). Urgent etiological treatment was needed in 332 (42 %) cases, and 248 (31 %) patients required hospitalization.
CONCLUSION: Diplopia accounted for 0.2 % of all ED admissions. Binocular diplopia predominated, with microangiopathies and strokes as leading causes. The use of imaging was high, even for monocular diplopia. The high rate of urgent treatments highlights the need for clearer imaging guidelines in emergency settings.
METHODS: We conducted a bicentric retrospective study of patients admitted for diplopia between January 2022 and December 2023 in the general EDs of two French university hospitals.
RESULTS: We included 788 patients admitted for diplopia, representing 0.2 % of all ED admissions. Binocular diplopia was predominant, accounting for 751 cases (95 %), with the most common etiologies being microangiopathies (250 cases, 33 %), strokes (140 cases, 19 %), and myasthenia gravis (36 cases, 5 %). Cardiovascular risk factor prevalence did not differ between monocular and binocular diplopia. Imaging was performed in 712 cases (90 %), including 694 cases (92 %) of binocular diplopia and 18 cases (48 %) of monocular diplopia. The imaging primarily consisted of magnetic resonance imaging in 550 cases (70 %), computed tomography in 283 cases (36 %), and both modalities in 121 cases (15 %). Urgent etiological treatment was needed in 332 (42 %) cases, and 248 (31 %) patients required hospitalization.
CONCLUSION: Diplopia accounted for 0.2 % of all ED admissions. Binocular diplopia predominated, with microangiopathies and strokes as leading causes. The use of imaging was high, even for monocular diplopia. The high rate of urgent treatments highlights the need for clearer imaging guidelines in emergency settings.