Acute diplopia associated with systemic hypertension - A case Report

Background: Microvascular ocular cranial nerve palsy can result from diabetes and hypertension and may be increasing with the increase in the incidence of diabetes and hypertension in Nigeria. Objective: This study provides clinical considerations for the neuro-ophthalmic evaluation of diplopic patients with presumed microvascular ocular cranial nerve palsy. Method: A case report is presented of a forty two (42) years old man recently managed for hypertensive emergency and was referred to our clinic following sudden onset of diplopia. A review of the neuro-ophthalmic evaluation of microvascular ocular cranial nerve palsy is presented. Result: Examination of the patient revealed a right acute esotropia. No other neuro-ophthalmic sign was found. Pupils and visual fields were normal. Resolution of diplopia was gradual and complete three weeks post presentation. A diagnosis of a presumptive microvascular right abducens nerve palsy associated with systemic hypertension was made. Literature reveals microvascular ocular cranial nerve palsy to be the most common cause of acute diplopia especially in the older age group. Conclusion: Microvascular diseases can result in acute diplopia. However, because certain sinister pathology such as intracranial neoplasm and aneurysm can present with acute diplopia, neuro-ophthalmic evaluation for red flags such as the presence of multiple palsies, bilateral palsies, pupil involvement, less than forty (40) years, non resolving diplopia and onset of new symptoms/signs should prompt consideration for referral for extensive neuro-diagnostic investigation.