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Constant Diplopia for Two Years, No Dx

As the title suggests, I've been suffering from diplopia for two years straight. Binocular horizontal diplopia, to be exact, with a cranial nerve VII palsy suggested. This is my second bout of diplopia, the first only lasting two weeks and occurring four years before this current bout. There were other symptoms and findings that led to many neurological and lab tests, all coming up with nothing. I thought. But I was recently going through my medical records to help prepare myself for an upcoming appointment and I noticed a lot of things that were never mentioned to me. I made a list, and I'm wondering if anyone has any ideas as to the significance of any of these things or combination of:

Cranial nerves:
Sixth nerve palsy
Second nerve abnormality - right side 20/30, left side 20/20 (but normal on some reports?)
Contradictory?

Eye:
Opthalmoplegia/Internuclear Opthalmoplegia
Right pupil 5mm, reacts to light and accommodation, "left pupil normal"
Non-specific changes on both VF with BB scotomas (?)
Esotropia at a distance
Anisocoria
Left eye vessel tortuosity
Pseudo disc edema
Abnormal VEP (results?)

MRI of brain and spine:
Cerebellar atrophy
Asymmetry of T2 signal adjacent to left occipital horn related to the ependymal apposition (?)
T2 hyperintensity of upper thoracic cord - thought to be artifactual
C3-C4 posterior spondylosis with bilateral uncovertebral anthropathy and a punctate right paracentral posterior annular fissure
C6-C7 posterior central disc protrusion with small annular fissure

Neurological exam:
Abnormal deep tendon reflexes, right ankle clonus measured at +3 and +4 on separate occasions
Delayed reaction bilateral patella

Other:
Microscopic hematuria - no cause found after blood tests, CT scan, and cystoscopy

Flagged labs:
Low BUN - 6
High globulin - 4.2
Low albumin - 9.8
Low igG CSF - 1.7
High pyruvate acid - 2.02 and 2.88 on separate occasions

Dx?:
Myelopathy
Internuclear Opthalmoplegia

Questions for my doctor:
What do these things mean?
Have I been tested for Lyme, EBV, other viral causes?
Is my vision and/or diplopia/paresis getting worse/better?
Please discuss any cranial nerve abnormalities found and if/how they differ from past findings
3 Responses
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Avatar universal
Sorry, cranial nerve VI palsy, not VII.
Helpful - 0
351246 tn?1379682132
MEDICAL PROFESSIONAL
Hi!
The internuclear ophthalmoplegia which you have due to disruption in conjugate movement of the eye (which may be mainly due to 6th cranial nerve palsy and partially due to the brain lesions), could be the cause of your dioplopia.
Along with that your blood tests point towards a metabolic disorder—so thyroid problems and diabetes should be looked at.
Usually patching one eye helps. Please ask your doctor. Hope this helps. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
Helpful - 0
Avatar universal
Thyroid and diabetes testing has been performed and everything was negative/normal.
Helpful - 0
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