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useful explanation of double vision caused by brainstem lesion
by doublevision1, Jun 23, 2008 11:24AM
The best explanation I have found for understanding my diplopia is in the handbook: "Multiple Sclerosis Care - A Practical Manual," (c. 2007) (Zajicek, Freeman, Porter). This is one manual in a series by Oxford Care Manuals, published in the UK. I found it on Amazon. It has tons of useful info on all aspects of MS.
This is what it says about double vision due to brainstem involvement in MS. It is quite technical in its description but helpful nonetheless:
"One of the commonest brainstem features is an internuclear ophthalmoplegia (INO), due to demyelination in the medial longitudinal fasiculus (MLF), which connects the pontine gaze cenre close to the VI nerve nucleus, with the contralaeral III nerve nucleus. In order to move the eyes laterally on voluntary gaze, the pontine gaze centre drives the eyes towards the same side by stimulating the ipsilateral VI nerve (pulling on the lateral rectus muscle), and the contralateral medial rectus via the opposite III nerve. Demyelination in the signal transfer to the contralateral medial rectus will slow or abolish adduction of the contralateral eye, often with abducting nstagmus in the ipsilateral eye. This is best tested by rapid alternating eye movements whilst the head remains still. Occasionally patients may complain that 'one eye isn't keeping up witht he other' or that they have to turn their head slowly in order to avoid double vision. More commonly, they may notice double vision, and sometimes they may not complain of any abnormality of vision, and these findings are only picked up on examination."
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This is what it says about double vision due to brainstem involvement in MS. It is quite technical in its description but helpful nonetheless:
"One of the commonest brainstem features is an internuclear ophthalmoplegia (INO), due to demyelination in the medial longitudinal fasiculus (MLF), which connects the pontine gaze cenre close to the VI nerve nucleus, with the contralaeral III nerve nucleus. In order to move the eyes laterally on voluntary gaze, the pontine gaze centre drives the eyes towards the same side by stimulating the ipsilateral VI nerve (pulling on the lateral rectus muscle), and the contralateral medial rectus via the opposite III nerve. Demyelination in the signal transfer to the contralateral medial rectus will slow or abolish adduction of the contralateral eye, often with abducting nstagmus in the ipsilateral eye. This is best tested by rapid alternating eye movements whilst the head remains still. Occasionally patients may complain that 'one eye isn't keeping up witht he other' or that they have to turn their head slowly in order to avoid double vision. More commonly, they may notice double vision, and sometimes they may not complain of any abnormality of vision, and these findings are only picked up on examination."
db
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What I've found is that my occasional double vision is because of fatigue, and with rest it gets a little better. I've also noticed that tracking things in my peripheral vision is just too tiring! I often don't bother trying to look at stuff that's not right in front of me, because it's too much work.