DrVirgo
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Choices:
A. CN III
B. CN IV
C. CN VI
D. CN VII
E. CN II
1. Vertical diplopia is due to palsy of which nerve?
2. A patient with recent history of bacterial meningitis has horizontal diplopia in left eye which is worse on gaze to the left. This is due to a palsy of which nerve?
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| reet
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1. vertical diplopia WORSE ON LOOKING DOWN ,,, B) CN IV palsy ( TROCHLEAR NUcleus in caudal MIDBRAIN)
2. horizontal diplopia WORSE ON GAZE TO LEFT ,,,,C) CNVI PALSY ( abducen nuc. in caudal PONS)
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| DrVirgo
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You are right reet.
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| zaidsuror
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yes you are right ,but regarding the verical diplopia couldn't there be a a occulomotor nerve injury in its branch supplying the the superior rectus or the inferior obligue.
or did you exlude it because practically a III PALSY WOPULD RESULT IN A (OUT AN DOWN EYE)PRESENTAION RATHER THAN MERE DIPLOPIA?
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| Harry Potter
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Few points.
Horizontal diplopia in left eye in the question stem is not correct. Diplopia occurs only when viewed by both eyes-i.e., binocular diplopia. Monocular diplopias are usually due to ocular causes-imamture cataract, corneal opacity, etc.
Horizontal diplopia:
If some one has horizontal diplopia on looking to left, it could be due to left abductor (6th nerve) or right adductor (3rd nerve) palsy. Diplopia more to far vision usually due to abductor palsy and diplopia due to near vision due to adductor palsy.
Vertial Diplopia: (images appear vertically separated)
Can occur due to weakness of any of the elevators or depressors.
If more on looking downwards-then it is due to SO or IR palsy
If more on looking upwards-then it is due to SR or IO palsy
hope that helps.
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| DrVirgo
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Thanks Harry, good explanation. 
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| Harry Potter
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You are Welcome Dr.Virgo
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