A 36 year old woman with diplopia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

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Presentation transcript:

A 36 year old woman with diplopia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology

Vignette A 36 year old woman with vertical diplopia, nausea and disequilibrium Maddox Rod testing supine demonstrated a decrease in the amplitude of vertical deviation compared to in the upright position Rasool et al. © 2015 American Academy of Neurology

Imaging Rasool et al. © 2015 American Academy of Neurology

Imaging Rasool et al. © 2015 American Academy of Neurology

“Upright-Supine” Test to Evaluate Vertical Diplopia Skew deviation is a vertical misalignment caused by a supranuclear lesion in the vestibulo-ocular reflex pathways The damage may be in the vestibular nerve, brainstem or cerebellum The amplitude of deviation is sensitive to gravitational forces The “Upright-Supine” test reliably demonstrates a reduction in vertical deviation with skew but not in infranuclear lesions In can be used at the bedside to determine the localization of vertical diplopia Rasool et al. © 2015 American Academy of Neurology