{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:59:45Z","timestamp":1775761185470,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008130","name":"Pusan National University Hospital","doi-asserted-by":"publisher","award":["202200380001"],"award-info":[{"award-number":["202200380001"]}],"id":[{"id":"10.13039\/501100008130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to investigate the clinical factors that predict abnormal radiographic findings in adults with acute onset binocular diplopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Medical records of consecutive patients aged &amp;gt;20\u2009years who presented with acute binocular diplopia were retrospectively reviewed. Patients were divided into positive and negative groups according to radiographic findings. Demographic and clinical characteristics were compared. The risk factors for positive radiographic findings were investigated, and the area under the receiver operating characteristic curve (AUC) was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 242 patients (145 males and 97 females), 44 (18.2%) were in the positive group and 198 (81.8%) in the negative group. Patients in the positive group were older (<jats:italic>p<\/jats:italic>\u2009=\u20090.005) and had more vasculopathic risk factors (<jats:italic>p<\/jats:italic> =\u20090.038). Severe duction limitation (&amp;gt;50% reduction in motility) was present in 90.9% of patients in the positive group and 56.1% in the negative group (<jats:italic>p<\/jats:italic> &amp;lt;\u20090.001). Abnormal slit lamp findings and pupillary exam abnormalities were also more frequent in the positive group than in the negative group (<jats:italic>p<\/jats:italic> =\u20090.027 and <jats:italic>p<\/jats:italic>\u2009=\u20090.036, respectively). Older age, higher intraocular pressure, abnormal slit-lamp findings, exophthalmos, and duction limitation were identified as risk factors for positive radiographic findings. A predictive model generated an AUC of 0.772.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Older age and vasculopathic risk factors were associated with underlying radiographic pathologies, supporting the recommendation that neuroimaging should not be delayed in those patients. Careful ophthalmic evaluations may guide diagnosis and decision-making for immediate neuroimaging in cases of diplopia.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1470805","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T05:10:37Z","timestamp":1732684237000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical predictors of causative radiographic findings in adults with acute onset diplopia"],"prefix":"10.3389","volume":"15","author":[{"given":"Yubin","family":"Son","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hie Bum","family":"Suh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hee-young","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle T.","family":"Cabrera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyeshin","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/aos.12062","article-title":"Acute-onset diplopia","volume":"92","author":"O'Colmain","year":"2014","journal-title":"Acta Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s10384-018-0617-2","article-title":"Causes, background, and characteristics of binocular diplopia in the elderly","volume":"62","author":"Kawai","year":"2018","journal-title":"Jpn J Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1016\/j.jemermed.2017.12.045","article-title":"Approach to a patient with diplopia in the emergency department","volume":"54","author":"Margolin","year":"2018","journal-title":"J Emerg Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.ophtha.2003.05.024","article-title":"Incidence, associations, and evaluation of sixth nerve palsy using a population-based method","volume":"111","author":"Patel","year":"2004","journal-title":"Ophthalmology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s10384-007-0489-3","article-title":"Cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy","volume":"52","author":"Akagi","year":"2008","journal-title":"Jpn J Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.jns.2003.12.003","article-title":"Acute ocular motor mononeuropathies: prospective study of the roles of neuroimaging and clinical assessment","volume":"219","author":"Chou","year":"2004","journal-title":"J Neurol Sci"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1097\/ICU.0000000000000200","article-title":"Management of acute cranial nerve 3, 4 and 6 palsies: role of neuroimaging","volume":"26","author":"Tamhankar","year":"2015","journal-title":"Curr Opin Ophthalmol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/ane.13425","article-title":"Acute-onset binocular diplopia in neurological unit: aetiological factors and diagnostic assessment","volume":"144","author":"Cerulli Irelli","year":"2021","journal-title":"Acta Neurol Scand"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"221","DOI":"10.3988\/jcn.2019.15.2.221","article-title":"Acquired ocular motor nerve palsy in neurology clinics: a prospective multicenter study","volume":"15","author":"Choi","year":"2019","journal-title":"J Clin Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"iv24","DOI":"10.1136\/jnnp.2004.053413","article-title":"Diplopia and eye movement disorders","volume":"75","author":"Danchaivijitr","year":"2004","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1001\/archophthalmol.2011.25","article-title":"Neuroimaging and acute ocular motor mononeuropathies: a prospective study","volume":"129","author":"Murchison","year":"2011","journal-title":"Arch Ophthalmol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"269","DOI":"10.3928\/01913913-20220201-01","article-title":"Trends in etiologies, demographics, and neuroimaging in new-onset adult strabismus at an ophthalmic emergency department","volume":"59","author":"Patel","year":"2022","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2264","DOI":"10.1016\/j.ophtha.2013.04.009","article-title":"Isolated third, fourth, and sixth cranial nerve palsies from presumed microvascular versus other causes: a prospective study","volume":"120","author":"Tamhankar","year":"2013","journal-title":"Ophthalmology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"b560","DOI":"10.1136\/bmj.b560","article-title":"Thyroid eye disease","volume":"338","author":"Perros","year":"2009","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/S0002-9394(14)70276-4","article-title":"Clinical features of Graves' ophthalmopathy in an incidence cohort","volume":"121","author":"Bartley","year":"1996","journal-title":"Am J Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/0002-9394(58)90223-X","article-title":"Comitant convergent strabismus with acute onset","volume":"45","author":"Burian","year":"1958","journal-title":"Am J Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1038\/s41433-022-01939-1","article-title":"Clinical characteristics and risk factors of acute acquired concomitant esotropia in last 5 years: a retrospective case\u2013control study","volume":"37","author":"Zhu","year":"2023","journal-title":"Eye"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1080\/08164622.2021.1914510","article-title":"Clinical characteristics and aetiology of acute acquired comitant esotropia","volume":"105","author":"Meng","year":"2022","journal-title":"Clin Exp Optom"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3928\/01913913-20121127-05","article-title":"Acute-onset esotropia: should we look inside?","volume":"49","author":"Schreuders","year":"2012","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1136\/bjo.79.5.498","article-title":"Acute onset concomitant esotropia: when is it a sign of serious neurological disease?","volume":"79","author":"Hoyt","year":"1995","journal-title":"Br J Ophthalmol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1470805\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T05:10:40Z","timestamp":1732684240000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1470805\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,27]]},"references-count":20,"alternative-id":["10.3389\/fneur.2024.1470805"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1470805","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,27]]},"article-number":"1470805"}}