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