First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes. A sixth nerve palsy can be caused by a variety of conditions including: ischemic (lack of blood) injury to the cranial nerve or the brainstem (I do no know what area you "mini strokes" are in); increased intracranial pressure, demyelination, or infiltration of the nerve by granulomas/infections/tumor.
If your 6th nerve palsy is due to your "mini-strokes" than it will just take time to improve (may not recover fully). Increased intracranial pressure is seen with tumors/mass lesions (which it sounds like your MRI did not show these) and pseudo-tumor cerebri (more correctly called: Benign Intracranial Hypertension) To evaluate for this possibility you should be checked by an ophthamologist for papellidema and have a lumbar puncture for opening pressure (typically 25-45 is the elevated range that would confirm the diagnosis). Another possibility is sarcoid, lymphoma, lyme, HSV, EBV, CMV all of which can infiltrate nerves. The best way to avoid this from happening again, is to find out why it happened this time.
I would recommend you get an lumbar puncture with opening pressure, Tourtelotte panel (IgG index/synthesis), oligoclonal bands, Lyme IgG/IgM, ACE, Cytology, flow cytometry for lymphoma markers and HSV, CMV, EMV, West nile PCRs.
I would recommend you keep one eye patched and switch the patch to the other eye every day or two.
I hope this has been helpful.
Hi,
Thanks for the helpful input. I forgot to mention, I do not have problems with diabetes, high blood pressure, or high cholesterol...
have you been checked for diabetes? do you have any stroke risk factors (such as high blood pressure, high cholesterol?). You should be checked for all of those. Sometimes a small stroke doesn't show up on an MRI. If your symptoms get worse or your doublevision is present on many directions, perhaps, your neurologist should consider another possibility, such as myasthenia. but it sounds like you've been worked up well so far.
A patch should help in reducing doublevision if you wear it on either eye at a time. It will, however, take away your depth perception while you're wearing the patch.
A lot of times eye-involving cranial nerve palsies do go away with time, 3-6 months, typically. But it is not always so.