Neuropsychological Correlates of Diplopia (Double Vision) in Motorists with Traumatic Brain Injury

Background: The symptom of double vision, known in ophthalmology as diplopia, is observed with various neurological conditions such as in multiple sclerosis, Parkinson’s disease, and the post-concussion syndrome. Our study examines the correlates of diplopia in survivors of high impact motor vehicle accidents (MVAs).

Method: Data on diplopia were available for 65 patients injured in MVAs (mean age of 38.1 years, SD=13.1; 24 men, 41 women). All patients were assessed using the Rivermead Post-Concussion Symptoms Questionnaire, Immediate Concussion Symptoms scale, the Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, as well as selected items from the Brief Pain Inventory (ratings of worst, least, and of average pain) and from the Whiplash Disability Questionnaire (ratings of depression, anger, and anxiety).

Results: Diplopia was reported by 27.7% of the patients. Ratings of diplopia correlated at a significant level (p<.05, 2-tailed) with the total Rivermead post-concussive score (r=.46) after the item “double vision” was removed from the Rivermead’s total score, and also with the total score on the PMNS scale (r=.35). Diplopia also correlated significantly with Rivermead’s post-concussive symptoms of blurred vision, oversensitivity to bright lights (photosensitivity), restlessness, dizziness, nausea, and problems with slow speed of thinking (the rs ranged from .30 to .57). With respect to individual items of the PMNS scale, diplopia correlated significantly to impaired balance, hand tremor, reduced control over hand or arm, and to some loss of bladder control (the rs ranged from .30 to .41).

Discussion and Conclusions: Diplopia was reported by 27.7% of survivors of high impact MVAs and was correlated with various other post-concussive symptoms, especially blurred vision, photosensitivity, and impaired balance.