Double vision, numbness, loss of coordination.

[heeroyuy88]

Hi I'm a 36 year old male with some interesting symptoms. Starting 3 days ago I woke up with double vision (only present in the center visual area when both eyes are open, normal vision if an eye is closed). Later in that day I started to have coordination problems, stumbling a bit. The following day the coordination problems seemed to increase and the double vision was still present. I went to the ER to get checked out. They did blood and urine tests and a MRI. The ruled out stroke, tumor and anything else from the tests. Basically they had no clue what was happening. One suggestion was Botulism. The ER discharged me and referred me to a neurologist (no open appointments for a month) and ophthalmologist (later today). By this time I also had some numbness in my lips, just light numbness. The third day I had light numbness also in the tips of my fingers. Today is the fourth day and I feel a little numbness in my hands/palms. The disoriented feeling is greater. I tried to just move around the house quickly and cannot. Any movement is exaggerated and slow. Getting up or sitting down is very uneasy and clumsy.  All the while I have the double vision and my head feels like its in the clouds. Any suggestions would be welcome, I'm afraid this will get worse.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

The differential is broad. There is one condition called acute inflammatory demyelinating polyneuropathy (AIDP, or Guillian Barre Syndrome) and variants of this condition that can cause similar presentations. (I mention this only because the tests you mentioned would not evaluate for this). Guillain Barre Syndrome (GBS) is a type of polyneuropathy (i.e., multiple nerve injury) that can result from an infectious source. One such source has been described in campylobacter infections, which is a GI infection. GBS usually presents with numbness/sensory changes beginning in the feet and progressing upwards. The major feature is weakness that is symmetric. There are variants to GBS that include a pure sensory form. GBS can be diagnosed, after three weeks of symptom onset, with an EMG/NCS and a procedure called a lumbar puncture (aka “spinal tap”). A variant is called Miller Fisher Syndrome which is characterized by ataxia (i.e., incoordination), areflexia of deep tendon reflexes, and eye movement abnormalities.

Why is botulism suspected? It is good that you had an MRI of your brain to evaluate, although not perfect, for other possibilities such as a vascular event or immune process (such as multiple sclerosis). I do agree you should follow up with a neurologist. I would also recommend that you discuss having a lumbar puncture performed.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[heeroyuy88]

Thank you so very much for the post. I did have a cold/flu the week before and had a few cases of stomach issues that needed antidiarhrea drugs for a few days to cure. I had put that up to the cold/flu but I wasn't eating well at the time and it could have been some bad chicken as that's my main protein source much of the time. I do have almost no registered tendon reflexes during my last doctor's appointment. I am also getting more and more tired each day and with increasing numbness. I will speak to my doctors about your suggested illness and am hopeful we finally have gotten an answer to what is causing my symptoms. Thank you for your help.