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Normal Findings?

Sep 19, 2013 - 0 comments
Tags:

diplopia

,

undiagnosed

,

findings

,

opthalmoplegia

,

internuclear opthalmoplegia

,

hyperreflexia

,

clonus

,

vessel tortuosity

,

pseudo disc edema

,

esotropia

,

scotomas

,

sixth nerve palsy

,

myelopathy

,

aniscoria

,

Abnormal deep tendon reflexes

,

Microscopic hematuria

,

Tactile dysesthesia

,

Chronic diplopia



Some history: first incidence of horizontal diplopia lasting approx. 2 weeks in 2007 before spontaneously resolving. Second incidence of horizontal diplopia currently; beginning in summer 2011. What do these findings mean? Why don't I have a diagnoses or treatment?

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

Eye:
Opthalmoplegia/Internuclear Opthalmoplegia on gazing to right and left
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? Normal on first exam, abnormal later?)

MRI of brain and spine:
Prominent cerebellar folia for age suggesting some 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
Response to stimulation by vibration decreased at both knees

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 codes:
Myelopathy
Opthalmoplegia
Internuclear Opthalmoplegia on Gaze to Right and Left
Tactile dysesthesia leg/foot

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