Intermittent Third Nerve Palsy.. suggestions??

[wonkyeye]

I am a 31 year old female and have been suffering from intermittent third nerve palsy of my left eye (eye gets stuck up and out, exotropia style) for over 17 years. Happens at least 1 day a week and sometimes 2-4 days a week. Each day that it happens it will last 15 minutes -2 hours (usually 1.5 hours) at a time and I will have anywhere from 3-7 episodes like this through out that day. The pain is quite severe on that side of my face (I compare it to a leg cramp) and my pupil dilates (doube vision, lose of balance) . Sometimes my speech actually becomes slurred and I have a hard time thinking or communicating but this I admit could simply be from the pure pain of this situation. I have been to several Neurologists (also Headache Clinics), Opthamologists, ENTs, regular drs, and no one seems to be able to figure this out. Currently the diagnosis is migraine/ cluster headaches with weird symptoms! Migraine medicine does not work (nor does Cluster headache therepy i.e. oxygen). I have been told that the following have been ruled out: Bells Palsy, Myasthenia Gravis, Aneurysm, Strabismus.

Any suggestions as to what could be causing this would be greatly appreciated as I have drs scratching their heads.

Thanks in advance!

[John C Hagan III, MD, FACS, FAAO]

Given the information your presented I think the working diagnosis is the best available (at least until new symptoms appear).

JCH MD

[wonkyeye]

Thank you for your reply.

I see a Neuro-Opthamologist next month.

Hopefully one day we will figure this out~

[John C Hagan III, MD, FACS, FAAO]

Good luck
JCH MD

[FRC23]

See a sleep center. Recurrent "Bells Palsy," memory problems, insomnia symptoms, chronic pain, and twitchy feelings in muscles are actually very characteristic of narcolepsy with cataplexy, and it can be exacerbated by the hormone shifts that happen with menstrual cycles. In fact, often times, people don't have "Bells Palsy," but cataplexy. Viruses and some vaccines (namely the H1N1) can actually precipitate this, but it can happen seemingly in random fashion, too.

Common misdiagnoses are depression, epilepsy, migraines, MS, and MG.

It doesn't look the way you think it looks. I struggled for years to find an answer, and was misdiagnosed several times. I had it with just sleepiness during the day and what looked like insomnia at night for probably about 15-20 years before I ended up with more serious symptoms of narcolepsy that actually included cataplexy (random muscle weakness that can either be isolated, or widespread). Onset is typically in teenage or early adult years but it can come later, and earlier, too.

The cataplexy manifested first in my face, as what looked like episodes of Bells Palsy that came and went when I was tired, stressed, or even when I was happy and smiling.  But when I paid closer attention I realized I got weakness and twitching (not uncommon) in my other muscles sometimes too, though I chalked it up to clumsiness until I paid attention. I also had issues with my vision randomly and sleepiness.

I went undiagnosed for about 15-20 years, until I finally saw a sleep specialist and she nailed the diagnosis right away. The vast majority of doctors have absolutely no idea what it is or what it looks like, and no routine lab tests, MRI, CT scan, x-ray or anything of that nature will detect it. 75% of people with narcolepsy never get diagnosed in their lifetime.

I was tested for epilepsy, migraines, MS, all kinds of things. But nope, it turned out to be narcolepsy!!

[JohnHaganMD]

=