Sixth Nerve Palsy Prognosis?

[norikyaki]

I am a 59 year old female who takes 100 mcg of Synthroid for hypothyroidism. I suddenly experienced double vision and headache on about June 14th of this year. I went to the eye doctor, who diagnosed me with Sixth Nerve Palsy, which is sometimes called Cranial Nerve Palsy.

He referred me to my neurologist, who ordered an MRI. It did not differ from my past MRI of 2003 from which had two small areas that were indicative of past mini strokes. This 2003 MRI was precipitated by Meniere's Disease.

I have had bouts of Bell's Palsy, migraine headaches, and Meniere's Disease in the past few years.

As far as the current problem, the doctors have said that the double vision from the Sixth Nerve Palsy should go away on its own in about 6 months. It's been 2 months already, and my vision is still too poor to even use the prism glasses sometimes given for this condition. Patches don't help, either, due to differing contact lens prescriptions in each eye. I am very frustrated at this and am worried about the patience of my employer while I am on short term disability.

1. Is there any treatment for Sixth Nerve Palsy other than "wait and see"? I have had success in the past with taking short-term steroids in the above conditions -- would they help in this case, too? I have been told surgery might be a last resort if it doesn't resolve itself...

2. Is there any connection with Bell's Palsy, migraines, Meniere's, and Sixth Nerve Palsy? Is there some type of inflammatory predisposition in my genes?

3. Is there anything I can do to avoid getting this Sixth Nerve Palsy again?

Thanks!

[CCF-Neuro-M.D.-SH]

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.

[norikyaki]

Hi,

Thanks for the helpful input. I forgot to mention, I do not have problems with diabetes, high blood pressure, or high cholesterol...

[vega1318]

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.