Im Seeing Double
Define monocular diplopia
Diplopia with only one eye viewing
Define action tremor
Oscillation that occurs or increases during voluntary movement
Define hypertropia
One eye elevated with respect the the other
Define polyopia
seeing multiple copies of an image
Define comitant
Diplopia that does not vary with gaze direction
Define exotropia
Eyes that are pointing laterally with respect to one another
Define binocular diplopia
Diplopia present only when both eyes are open
Define essential tremor
Isolated postural or action tremor involving the hands and sometimes the head and voice without other neurological findings. genetically determined with positive family history
Define rest tremor
on oscillation that occurs with the affected body part at rest, during no action.
Define task specific tremor
A tremor elicited by a specific task, such as speaking or writing
Define intention tremor
A typeof action tremor in which an oscillation occurs orthogonal to the direction of movement and increases in amplitude as the target is approached. Usually denotes disease of the cerebellum or its connections.
Define postural tremor
Define Esotropia
crossed eyes; eyes pointing medially with respect to the other
Apply interview framework questions for a person experiencing tremors.
What made you decide to come in at this time?
What concerns you the most about the tremor?
Tell me more about the tremor.
Define the term Phoria
tendency for eyes to be misaligned when one eye is covered; with both eyes open, the subject ocular motor control system can use vision to align the eyes so that there is no diplopia
Name differential diagnosis for the following:
1. Graves opthalmopathy, Orbital myositis, Muscle entrapment
2. Myasthenia Gravis, Botulism
3. Microvascular disease, Tumor, Infection, inflammation, cerebral aneurysm
4. Stroke, tumor, demyelination, infection
define psychologic tremor
irregular oscillations during maintenance of a posture, which usually disappear when the eyes are closed or a gravity load is placed on the muscles
Apply interview framework questions for a person experiencing diplopia
Does double vision disappear when one eye is closed?
Does it hurt?
How long have you had double vision? Is it getting worse?
What are differential diagnosis for the following:
1. Primary tremor
2. Secondary tremor
1. Essential tremor, Parkinson's (Multisystem atrophy, Progressive supranuclear palsy), Wilsons disease, dystonic tremor, psychogenic tremor, cerebellar dysfunction, midbrain tumor
2. Medications, fatigue, anxiety, fear, amphetamines, bronchodilators, peripheral vasoconstrictors
Determine the most likely diagnosis for the following:
1. Cataract (Elderly), Dry eyes
2. Abdustion or adduction muscle weakness
3. Left IV nerve palsy, convergence insufficiency
4. Graves opthalmopathy, Myasthenia Gravis, IV nerve palsy, III nerve palsy
Define enhanced psychologic tremor
psychologic tremor is increased in amplitude due to lack of sleep, fatigue, treatment with certain drugs, some endocrine disorders, caffeine use, or stress
What are alarm symptoms of tremors?
R,P,A with altered mental status, seizures, cardiac problems, R,P,A with new onset hemoparesis, sensory loss, diplopia,, dysarthria, P,A with anxiety, emotional lability, pain
What are serious causes of diplopia?
Cerebral Aneurysm, brain tumor, cavernous sinus mass lesion, increased intracranial pressure, infection
What are alarm symptoms of diplopia?
Eye pain or headache, facial numbness, facial weakness, limb weakness, limb numbness, imbalance, drowsiness
Define serious causes of tremor
Intoxication or toxic exposure, CNS lesion, Alcohol or drug withdrawal