Episode 428: Neurology VMR – Diplopia and fever

Nov 2, 2025

Dr. Yousuf Patel, a neurology resident from Cape Town with diverse medical training, presents a compelling case of diplopia and fever. He dives into distinguishing types of diplopia and the crucial role of the medial longitudinal fasciculus in gaze coordination. The discussion uncovers potential infectious causes linking fever with diplopia, addressing key diagnostic elements. A surprising link to Behçet's syndrome emerges through patient history and MRI findings, showcasing the importance of a thorough examination in uncovering complex neurological disorders.

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ADVICE

Systematic Approach To Diplopia

Distinguish monocular from binocular diplopia early to separate ophthalmologic from neurologic causes.
Work from the eye outward: muscles → nerves → cavernous sinus → brainstem to localize pathology quickly.

INSIGHT

MLF Explains Complex Eye Movement Findings

The medial longitudinal fasciculus (MLF) coordinates conjugate eye movements and connects multiple cranial nerve nuclei.
Lesions here can produce complex diplopia and affect vestibulo-ocular and vertical movements.

ADVICE

Think Emergencies With Fever And Diplopia

In diplopia with fever, actively search for orbital cellulitis, cavernous sinus processes, and raised intracranial pressure causing false localizing sixth palsies.
Prioritize urgent evaluation because these causes can be emergency threats to vision and life.

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Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Dr. Yousuf Patel presents a case of diplopia and fever to Vale and Sebastian.

Yousuf Patel

Dr. Yousuf Patel is currently a resident in neurology in Cape Town, South Africa. He completed his undergraduate training at Stellenbosch University. He holds post graduate qualifications in emergency medicine, occupational medicine, and travel medicine. In addition to this he also attained a BA in Philosophy & Sociology, and a masters equivalent in theological studies. His work experience includes sports medicine, emergency medicine, maritime medicine, and relief medicine where he has been able to travel to various regional and international relief sites. Other than his interests in neuroscience, physical health, and health equity, he is passionate about ethics and metaphysics.

Valeria Roldan (@valeroldan23)

Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.

Dr. Sebastian Green ( @sebfgreen )

Dr. Sebastian Green is a neurology resident at the University of California, Los Angeles (UCLA). He was born and raised in London, England. He has degrees in Medicine from the University of Bristol and Neuroscience from the University of Oxford. He has published on neuroimaging, memory, sleep, epilepsy, and more. He is passionate about medical education in neurology, and using EEG to answer big questions about the brain.

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