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  • 3rd Nerve Palsy 33 year old Female

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    Old 11-05-2010, 10:42 AM   #1
    michaelfox13
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    3rd Nerve Palsy 33 year old Female

    My wife Ruth is 33 years old. She is a nutritionist and personal trainer. She is in great shape and has been in very good health over the years. Recently, on a trip to California, she woke up in the morning and had uneven pupils. This was a sudden onset since the day and evening before, all was ok. Other than her vision being off, at the time we noticed it, there were no other real symptoms, other than being uncomfortable from her vision created by the uneven pupils. We went to a local emergency room in Palm Springs, where she was given an MRI with contrast, which came back clean. The emergency cleared with their eye surgeon for us to travel back to Philadelphia as scheduled. They did clear us, but we visited another eye surgeon in San Diego who also cleared us to fly.

    Next, to make a long story short, we went to see my friend, an eye surgeon, who felt she was fine, but since he was our friend, referred us to his friend, a neuro-opthamologist at Wills Eye Hospital in Philadelphia. The neuro-opthamologist did an exam, and when Ruth would look up high or down low, she had some double vision, additionally, he noticed a slight droop in her left eyelid, the same eye that had an enlarged pupil.

    He sent us to the emergency room downstairs. He felt she had 3rd nerve palsy, which as explained is typically brought on by a tumor or anurism. He wanted us to get another MRI with contrast, a cat scan A, and if necessary, an angiogram. In addition, they drew blood and tested for everything from MS, Limes Disease, Lupis and many others. We first did the MRI with contrast which came back clean, next the cat scan came back clean, they wanted to do an orbital MRI the next day. They spent an hour looking, but did not find anything. Finally, they did the angiogram, which came back clean. The blood results have all come back clean as well so far. We had another Neuro Surgeon at Cooper Hospital review all the studies previously mentioned, and he did not see anything either..He felt they were all clean as well.

    This process started October 18th when we were in Palm Springs. We ended up in Wills Eye Hospital on October 19th where all testing was performed over the next couple of days. We then were released from the hospital and went back for a follow-up with the Neuro-Opthamologist a week later. The pupil was still dialated, and their was a slight droop in the eyelid, but nothing got worse. We have an appointment the week of Thanksgiving to follow-up again. In the meantime, they do not know what is causing this and have ruled out Adies pupil. We are monitoring things for now, but are very frustrated, that a team of Neuro physicians do not know where this coming from.

    We reach out to you for two reasons:

    1. To see if you have had any similar patients in the past and can give us guidance on what happened with them or any diagnosis that was made.

    2. If the answer is no to the above, then do you have any ideas what might be causing the 3rd nerve palsey?

     
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    Old 11-26-2010, 04:00 PM   #2
    jverive
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    Re: 3rd Nerve Palsy 33 year old Female

    You might want to look up "pseudotumor cerebri" or "Ideopathic Intracranial Hypertension." They are two names for the same syndrome, which usually manifests itself as double vision and/or unequal pupil size without tumors or other findings in MRIs or other imaging studies. The incidence for this condition is around 1.5 to 3.5 in all women in the US general population, and increases about four or five times this amount in women who are overweight.

    This may or may not be what your wife is dealing with, but it's a reasonable place to start looking for answers. I wish you the best.

     
    Old 01-10-2011, 03:36 AM   #3
    praveer
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    Smile Re: 3rd Nerve Palsy 33 year old Female

    Quote:
    Originally Posted by michaelfox13 View Post
    My wife Ruth is 33 years old. She is a nutritionist and personal trainer. She is in great shape and has been in very good health over the years. Recently, on a trip to California, she woke up in the morning and had uneven pupils. This was a sudden onset since the day and evening before, all was ok. Other than her vision being off, at the time we noticed it, there were no other real symptoms, other than being uncomfortable from her vision created by the uneven pupils. We went to a local emergency room in Palm Springs, where she was given an MRI with contrast, which came back clean. The emergency cleared with their eye surgeon for us to travel back to Philadelphia as scheduled. They did clear us, but we visited another eye surgeon in San Diego who also cleared us to fly.

    Next, to make a long story short, we went to see my friend, an eye surgeon, who felt she was fine, but since he was our friend, referred us to his friend, a neuro-opthamologist at Wills Eye Hospital in Philadelphia. The neuro-opthamologist did an exam, and when Ruth would look up high or down low, she had some double vision, additionally, he noticed a slight droop in her left eyelid, the same eye that had an enlarged pupil.

    He sent us to the emergency room downstairs. He felt she had 3rd nerve palsy, which as explained is typically brought on by a tumor or anurism. He wanted us to get another MRI with contrast, a cat scan A, and if necessary, an angiogram. In addition, they drew blood and tested for everything from MS, Limes Disease, Lupis and many others. We first did the MRI with contrast which came back clean, next the cat scan came back clean, they wanted to do an orbital MRI the next day. They spent an hour looking, but did not find anything. Finally, they did the angiogram, which came back clean. The blood results have all come back clean as well so far. We had another Neuro Surgeon at Cooper Hospital review all the studies previously mentioned, and he did not see anything either..He felt they were all clean as well.

    This process started October 18th when we were in Palm Springs. We ended up in Wills Eye Hospital on October 19th where all testing was performed over the next couple of days. We then were released from the hospital and went back for a follow-up with the Neuro-Opthamologist a week later. The pupil was still dialated, and their was a slight droop in the eyelid, but nothing got worse. We have an appointment the week of Thanksgiving to follow-up again. In the meantime, they do not know what is causing this and have ruled out Adies pupil. We are monitoring things for now, but are very frustrated, that a team of Neuro physicians do not know where this coming from.

    We reach out to you for two reasons:

    1. To see if you have had any similar patients in the past and can give us guidance on what happened with them or any diagnosis that was made.

    2. If the answer is no to the above, then do you have any ideas what might be causing the 3rd nerve palsey?

    Hi michaelfox,

    Just read your problem and found that I share exact the same problem with your wife.

    On 30 Dec 2010 (Friday) I found that I have to stress a bit and takes 1-2 second to focus on the object to be visible clearly with migraine. I consult an eye doctor for the checkup, for double vision and my pupil is larger than the actual size and eye is red. (left eye only) He asked me to come for further checkup on Monday.

    But on Sunday my eyes were behaving weird and I can see 2 vision at a at approx 50-60 degrees.
    Someone suggested me to consult neurologist.
    I checked with a neurologist, and confirmed third-nerve palsy and he advised me of MRI, retina movement MRI, diabetes and ANA blood test. I did and All were clean.
    Now after a week of medication (mainly steroid) I got single vision but now I see the shaking image through my left eye only and it is very disturbing.
    It takes more time if I see keyboard and then the screen while working (yes I am back on work now ) I spoke to my doc about the problem and according to him it will be fine after few days and kept me on medication for next 10 days (reducing slowly).
    I feel like mild-tremor when I see with my left eye and it feels like someone is shaking my eye-glasses.
    I want to know, if the situation was same with your wife and how is she now? does she feel the same shaking image and how much time it takes to recover.

     
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    Tags
    anurism, brain tumor, neuro-opthamology, third nerve palsy



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