Maladies cardiovasculaires et diagnostic

Monocular Diplopia Associated with a Midbrain Stroke

Abstract

Santoshi Billakota and Larry B. Goldstein

Background and Purpose Monocular diplopia is often due to intraocular disease. It is rarely the result of cerebral causes, which include lesions in or near Brodmann’s area nineteen, the frontal eye fields or the cerebellum. Monocular diplopia has not been reported in a patient with a midbrain lesion. Methods and Results A patient with a history of hypertension presented with right monocular diplopia and headache. There was no ocular cause of the patient’s symptoms, and aside from bilateral ptosis, there were no relevant findings on neurological examination. MRI brain revealed an ischemic stroke affecting the right oculomotor nucleus. Her evaluation, including an ECG and 48-hour Holter monitor was unremarkable. A subsequent 30-day auto-trigger cardiac event monitor revealed paroxysmal atrial fibrillation. Conclusions This case shows that monocular diplopia can be associated with a midbrain lesion and underscores the importance of prolonged cardiac monitoring in patients with otherwise cryptogenic stroke.