Superior Oblique Palsy or 4th Cranial Nerve Palsy

[pamk5]

I was at the NL today trying to get help with headaches while I wait on an appt with NS, he noted issues with my eyes and sent me over to an opthamologist today.  My headaches have been behind my eyes, back of head and neck, but also alot of stabbing pain in my eyeballs.  Well it seems this 4th Cranial nerve that comes from the back of the neck can be affected and cause a problem.  The treatment was a prism put over the lens of my existing glasses and the stabbing pain in my eyeball is gone, at least for the moment.  Not sure if this is from the whiplash injury or Chiari, she wasnt sure.  But it seems to me if the issues with Chiari are coming from the neck it could be.  I cant find anything on this but is a possibility I think.  Anyone else have this issue?  

[umdlotus]

Also, this is from:http://www.oculist.net/downaton502/prof/ebook/duanes/pages/v6/v6c086.html

Defects in superior oblique muscle function can be either congenital or acquired. Both are manifested clinically as incomitant hypertropia, A-pattern strabismus, torticollis, and vertical or torsional diplopia. Patients undergo surgery to correct the superior oblique muscle function most often to weaken an “overacting” muscle or strengthen an “underacting” muscle. Superior oblique muscle surgery is occasionally performed to compensate for trochlear dysfunction (e.g., Brown's syndrome) or as part of the management of strabismus problems not directly involving the superior oblique muscle. In most cases, superior oblique muscle dysfunction presents as an isolated finding, associated only with other strabismus disorders. A few may be part of recognized syndromes (Apert's, Crouzon's), craniocervical junction deformities (Chiari's malformation), or neural tube defects (meningomyelocele).1,2 Familial transmission has been reported.3–5 Occasionally, myasthenia gravis may present as superior oblique muscle weakness.6

[umdlotus]

Hello Pam

I know this is totally late but...
This may help
http://www.chiariconnectioninternational.com/docs/Symptomatic_ACM_and_Cranial_Nerve_Dysfunction.pdf

I too have this condition and chiari, and have had head trauma BUT -- it started before the head trauma.

Hope you're doing OK

[pamk5]

Seems that is what NLs know.....drugs and more drugs, and none of them work!!  I am sick of taking pills, the more you take the worse you feel.  It seems that over the last 5 years I have gotten very drug sensitive and now have a list of allergies.  And thats all I need at this point is to have another drug reaction to make me feel worse.  

[selmaS]

Yes, I was on Gabapentin...it really didn't help me sleep or with HA's...and it did affect my IBS, so I had to stop them....

I am not sure neone that had ne major success with these meds...some say they start out working then seem to wear off....

"selma"

[pamk5]

Yes lots of issues with lights at night, the moon literally looks like someone smeared it.  Tail lights, street lights all cause a problem glaring and streaking.  I am thankful not to have the horrible eye pain.  Maybe something to ask the eye doc about for anyone suffering from the same thing.  

The NL gave me Depakote and I opted not to take it.  Especially since I had a horrible reaction to Nortriptyline a week ago, I am a little gun shy about trying new drugs at this point.  

I go to NS next week so hopefully I will get some answers then or at least some options.  Right now the only thing I have is Immitrex and Pheneragan.  

[*Stormy*]

Wow, that's really interesting about the prism, I have never hear about that but it is very interesting!! Do you find that you have trouble with glares and streaks caused by lights (say headlights for instance)? I get that bad enough that I am scared to drive at night because it is so hard to see. I'm so glad you've had some relief with the pain though!!

As for the meds, a lot of us get put on Gabapentin which is an anti-seizure drug and others like it for things like headaches, restless legs, tremor etc.. I think the big difference is they usually give us a much lower dose than they give people who actually have seizures so it would probably be the same for you. All of these things help to work on an overactive nervous system so you can see why they might help. For myself, I didn't have the best experience with the Gaba and switched to Lyrica instead which was better. However, I was trying to ease body pain and be able to sleep at night, not so much for curing the headaches (surgery helped a lot with that!)

Take care
Carolyn

[pamk5]

They just called it a Rennell prism the optical shop put it over my lens on my existing glasses just in my right eye.  Must be magic because the eye pain is gone.  Still!  At least something is working.  

The thing that helped her decide this was the other night I looked up at the full moon and it looked like it was a skewed cylinder.  Pretty weird huh?  Like there were 2 with blurred sides connecting them.  My understanding you cant tell unless you are trying to focus on something far away (like the moon).  

Something to ask more about.  This prism is like a sticker they put over your glasses took about 15 minutes and you cant it is there.  She said that if it turned out to be permanent that they grind it into the lenses.  

Now have you ever taken seizure drugs to help with the headaches?  I am pretty afraid of this approach with the possibility of steven-johnson syndrome and everything else.  If I was having seizures would be different I would feel the benefits outweigh the risk.  Just curious?

[selmaS]

Hi...many have complained of eye pain...not sure if we were told it is a result of the 4th nerve....

I too had whiplash....and have had similar pain...but I did have surgery...still have some issues, but none of the pain I have now is the same as b4.

I am interested to hear more about this prism..can u explain it in more detail???

"selma"