Double Vision in 15 year old

[tina21067]

Happy Superbowl Day Everyone,

I haven't posted about myself in a little while as I am on the back burner because my son has been having eye issues since early December.  Actually this happened to him last year, almost a year to the day, that his latest stint with intermittent double vision.  

Last year,about 3 weeks after he finished his football season, he came home and told me he was seeing double vision.  This was happening off and on for about a week before I heard about it (not too happy about that).  After a very harrowing and frightening 3 weeks and all types of testing, it resolved on its own and he was great for just shy of a year.  Not even one other incident of double throughout the year or during football season.  

Fast forward to early December and he tells me it is happening again.  I wasn't as freaked out about it this year, because they ruled out most of the really scary stuff last year by doing MRI's, an MRA and lots of blood testing.   This year they have repeated the MRI's and we have seen just about every type of doctor known to mankind, opthamologists, neuros, neurosurgeons and neuropthamologists.   We have seen doctors here at Yale and we were referred to Boston Children's Hospital who are supposed to be #1 in the country for children's neurology.  

No one can figure out what is going on.  They suspected a cranial nerve palsy, but they don't see anything on the scans.  Since it is intermittent, it is hard for them to see it actually happening.  They tried to put the "stress" label on it which really irked me.  Thank goodness for my wonderful pediatrician who doesn't buy that either.  One of the neurosurgeons even suggested to us that teenagers "are more aware of their bodies that older people."  Whatever the heck that means....

His MRI's showed that he has an arachnoid cyst in the posterior fossa.  Not one doctor believes this could be causing this.  No one told us why, except for the wonderful neuro at BCH.  He stated it is showing no compression because it has lobulated edges, the fluid inside it appears to be clear not cloudy, it hasn't increased in size since last year and he has no bone thinning of his skull in that area.  They said his MRI's looked perfect and his neuro exams were excellent.  That doc told us he should return to exercising and working out with his team.  It seems crazy that we can't figure this out.  

I guess what I am asking is are any of you familiar with a 4th cranial nerve palsy?  The description of this seems to fit his condition perfectly.  When he looks down and then back up, the double always happens.  It will stay that way for awhile and then clear itself.  Sometimes it goes to double while he is looking straight.  Last year it lasted 3 weeks and went away and happened maybe 20-25 times a day.  This year it happens many times an hour (much worse than last year) and has been happening about 8 weeks now.  He also says his right cheek has slightly decreased sensation.  We are stumped with this.....the doctors don't seem concerned now because all of the bad stuff, thank God, has been ruled out.  The only one who seems concerned is my pediatrician.  He gave us migraine nasal spray but it hasn't worked.  He mentioned steroids when I spoke with him last week before the spray.  Do you guys have any ideas or suggestions as to stuff we should be looking at?

Thanks in advance!

PS  We were trying to get an MRI of his eyes and eye orbits, but the insurance company denied it because of the brain MRI's he has had.  Maybe I can get them to reconsider because we are not getting any real answers.

[twopack]

Hydrocephalus usually occurs when improper CSF drainage causes an enlargement of the ventricles that is visible on MRI.  PTC causes increased CSF pressure without ventricle enlargement (they may appear normal or slit-like on MRI).  

I think a clearer sign for diagnosis is a high opening pressure during a LP.  Opening pressure is the CSF pressure measurement the doctor takes before removing any fluid.

I'm close to exhausting what I know about this condition.  Truthfully, I don't even know if you'd need to ask a neuro or an ophthalmologist about this diagnosis.  I think there are times that either/or may be involved.

[tina21067]

My apologies for my horrible grammar and spelling in my earlier post.  I am exhausted and trying to do double duty with posting and watching the Superbowl.

[tina21067]

Thanks for responding Twopack.

No one has mentioned that as a possibility.  They did say that from the MRI scans that there was no hydrocelphus (spelling?)  Is pseudotumor cerebri different?  If so, is it something that would be seen on his scans?

Thanks so much, Tina.

[twopack]

Sorry to hear about all this trouble with your son Tina.  It's bad enough to live with uncertainties about our own health but when it's our kids that aren't getting answers.... well, the stress soars.

This would be a long shot, but do you know if they ruled out a condition called pseudotumor cerebri?  DON"T panic seeing that "T" word stuck in the middle.  This isn't any kind of growth.  It's a build up of spinal fluid pressure - kind of like high blood pressure of the brain.  I believe it is possible for it to come, disappear and then return again.  I just don't know how likely it would be in a teenage male.  It's a treatable condition though so might be worth investigating (if you don't mind taking a risk of being laughed out of the doctor's office - which mother's usually don't care about).

Good luck to you both.  Please let us know how it’s going.