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Thread: double vision/ approx. 4-5 months after injury. Not brain, or optho.

  1. #1

    double vision/ approx. 4-5 months after injury. Not brain, or optho.

    Son is not on any medication. 4-5 months after accident, he has double vision. This has lasted over three months.
    Neuro-optho orders brain mri, no damage to brain or anything eye related. Sinus issue only. Ent puts him on antiobotics and steriods, but does not think infection is effecting vision.
    QUESTION;What in the spine, could effect his vision?
    ( any theories, appreciated...I will research any possibilities)

    T5678 Compression fractures. cord contusion edeama. L5-s1 2.5mm disc bulge. Loss of light touch sensation following an s1 dermatone pattern right side. Hyper-sensitive left side etc.No sensation to feel bladder.But can urinate, minimal leakage. Two episiodes of Autonomic disreflexia. Severe pain in neck (mri-ct clear on cervical) But I don't believe this is true. Severe pain lower back.
    Thank-you again,
    Diana

  2. #2
    Just because an MRI is negative does not mean there was no brain damage in the accident. This is common in mild to moderate TBI. The neuro should know this. What did he/she say?

    Occasionally you can get a Horner's Syndrome with a cervical spinal cord injury that does not resolve. This generally is more likely to cause problems with some blurring and focusing rather than double vision though.

    (KLD)

  3. #3
    Neuro-optho nurse called and said report was normal. He has not seen disc, that I am aware of. Unless it was sent electronically, which is likely as he ordered mri. They did images with and without contrast. We still have appointment with him, coming up.I will read more about horners, I read it briefly just now. His eyes appear normal looking. There are other new issues with vision, as well as double vision. He does get headaches. Also, he does have some issue with dilation of pupils.But briefly reading about Horners, I'm not quite sure about this. But I will definetly research it more.
    *** I just read some more on this...Cervical ganglia, (horners)I am wondering about the nerves to and from t-5, where he had only 15% compression fracture. I think, but not sure cord runs into t5? Does Cervical Ganglia nerves or Nerves related to horners syndrome also follow this path? I followed ganglia nerves all the way to maxillary compartment. It certainly is interesting.
    *** I will definetly throw this possibility at Neuro-Optho.
    Question; Can this be detected with lab (blood) work?
    I read this article and found it interesting, how valid is this;

    Department of Ortopaedics, Umeå University Hospital, 90185 Umeå, Sweden. Michel.Guez@orthop.umu.se
    Clinical examination is the only tool available to assess the extent of the nerve tissue damage after a spinal cord injury, and it is well known that the reliability of classification based on clinical examination is not satisfactory, especially in cases with incomplete motor injuries. There is a need to evaluate new methods in order to improve the possibilities of classifying and prognosticating spinal cord injuries. Methods for assessing central nervous system (CNS) damage using markers in cerebrospinal fluid (CSF) have recently been developed. Previous studies have reported glial fibrillary acidic protein (GFAp) and neurofilament protein (NFL) levels in non-traumatic diseases in the central nervous system. The present study is the first report of GFAp and NFL levels in CSF after trauma to the cervical spine. Six cases with cord damage and pronounced neurological deficit showed significantly increased concentrations of both GFAp and NFL in the CSF. Patients with tetrapareses showed higher values than those with incomplete injuries. Three of the 17 whiplash cases had increased levels of NFL, but normal GFAp. Assessment of nervous tissue markers in CSF will probably improve possibilities to classify and prognosticate spinal cord injuries and also to evaluate pharmacological intervention. The increased levels of NFL in three whiplash cases indicate neural damage in a proportion of the cases with neurological deficit. Neurological examinations are presently the only tools for grading and prognostication of spinal cord injuries. Assessment of nervous tissue markers in CSF makes it possible to quantify the degree of nerve cell damage after different types of cervical spine injury ranging from spinal cord lesions to whiplash injuries.
    PMID: 14577863 [PubMed - indexed for MEDLINE]

    TBI, this sounds quite frustrating. It sounds more like yes it could be, but again...no solid visual evidence. Very frustrating, that imaging studies cannot just give me the quick answer I would like.
    Are there any other possibilities?
    I would like to research as many as possible.
    Thank-you,
    Diana
    Last edited by uuudianauuu; 02-09-2008 at 09:53 PM.

  4. #4
    Would a Csf leak, show on mris?
    And if not, is a lumbar puncture the only way to tell if this is issue?
    I read about a nasal test, that can detect csf in nasal mucus. Have you heard of this? I am thinking if this is reliable, it would be the less evasive test.
    Thanks,
    Diana

  5. #5
    Testing for CSF in the nose or ear is only done to detect serious skull fractures. I assume he does not have this. A CSF leak is generally diagnosed from the spinal cord dura by symptoms. It will not show in an MRI unless it is very large, and even then it is hard to see.

    (KLD)

  6. #6
    Diana,

    Double vision does not necessarily indicate traumatic brain injury. If your son did not have this after injury and then developed the double vision, this suggests that it is from some other cause that developed since that time. I am sorry if I had missed any discussion on this subject but why are you thinking of or looking for a CSF leak? It would be very unusual this late after the injury.

    Double vision usually arises when the eyes do not move synchronously or malaligned so that images from the two eyes are mismatched. If the condition is consistent and persistent, the brain shuts down the image from one eye so that the double vision does not occur. However, if the eyes are usually synchronized and occasionally gets out of synchrony, the double vision may persist for long periods.

    The formal medical word for double vision is diplopia (this is so that you can look it up on internet). It may arise either from a problem with the eye or a problem with the muscles or part of the nervous system that controls the eye. There are many causes of diplopia. It is fixable. Your comments suggest that your son has seen a neuro-opthalmologist. What diagnosis does he suggest?

    The tests should show whether there is a problem with the eye, with the muscles controlling the eye, or with the nervous system. The fact that the diplopia is persistent suggests that it is occurring intermittently. Does it occur most frequently when your son is tired? If so, this is usually suggestive of a muscle problem.

    Does your son wear glasses?

    Wise.
    Last edited by Wise Young; 02-19-2008 at 09:01 AM.

  7. #7
    Thank-you, for responding. My on off button broke on cpu, I had to get this fixed. Sorry I took so long to respond.
    Neuro-Optho can't find why son is having diplopia. His vision was near perfect prior to crash. The double vision is in both eyes and is all the time. His vision changed sometime after crash. He mentioned it sometime around November, but isn't sure exactly when it started. Five months after crash. He is now wearing glasses, but still has double vision.
    Neuro-Optho is not sure why this happened. He does think it is odd, that his vision has changed so much.( Near perfect one and a half years earlier) He doesn't have an answer. He did say son does not have Horners.
    I was looking for answers...as usual. I was thinking csf leak, as this is one of symptoms. I did not realize this would happen shortly after injury.What else could it be, I just don't know? Maybe, its all just a coincidence.
    Maybe its related to autonomic dysreflexia.??? Who knows. We go back to Urologist on 25th, regarding him being unable to urinate except when bladder is very full.
    (Once per day approx.)
    The funny thing is that he has had two episodes of this. Which is usually seen in injuries above t6. His highest documented injury is t5.( I just keep coming back to cervical area)
    Very frustrating.
    I sure hope his vision just gets better.
    We are to go to downey rehabilation soon. So... I guess, I just cross my fingers, for answers.
    Thank-you ,
    so much!
    Diana

  8. #8
    Dr. Wise,
    I am wondering....as usual, Obviuosly I am a bit...obsessed with answers. Possibly, likely... obsessive compulsive disorder.(lol)
    My father is pretty much an inventor, engineer, etc. He has a photo graphic memory ( I was not blessed with this). He steers towards electronics. He was the one that invented underwater voice communication. Before him, you could not talk underwater. I don't know alot about him. He is living in Sacramento now.I was not raised by him. But, I do know he would do anything for his children.
    He did not grow up the normal way. (Orphan), At 15 he went to Korean war, he became a radio ham operator..someone took an interest in him.
    He never did anything medically, that I am aware of. But, I do know he did something with the goverment in geologics, and later something to do with vibration and friction etc. He worked for General Dynamics for years (he had his own lab). He also is above and beyond in math, computers etc. I read an article he wrote on something to do with boat engines( a hobby, at the time ), using simple algebra. (not simple, for the average person) He has dipped into much more than I am mentioning. ( I just googled him, and now he is apparently doing something with meteor electrophonics)He is one of these people that are far above the norm regarding IQ.
    I am wondering...how brilliant are you? I am thinking quite brilliant. But, am very curious, about what drives you....are you like my father...so above and beyond smart? ( I know this sounds like an odd question, but I happened to cross paths with an engineer, Professor,(CAL POLY POMONA) who is working on a cure for Aids.(AFRICA) He also wrote a book on vibration, in air space. He had heard of my father, and told me he wished he could get people like him in one room.)
    The cord is like the wiring in electronics, right? ( With the exception, I am thinking...we are not wired identically)
    My father is getting up in years, but...still dips into various subjects. Can I ask him to help you in anyway?
    ( sorry, I know this is out there. But he really is above the norm. I did not in-herit his IQ. But, I do believe I inherited his curiousity.)
    Diana
    Last edited by uuudianauuu; 02-23-2008 at 04:23 AM.

  9. #9
    Quote Originally Posted by uuudianauuu
    Thank-you, for responding. My on off button broke on cpu, I had to get this fixed. Sorry I took so long to respond.
    Neuro-Optho can't find why son is having diplopia. His vision was near perfect prior to crash. The double vision is in both eyes and is all the time. His vision changed sometime after crash. He mentioned it sometime around November, but isn't sure exactly when it started. Five months after crash. He is now wearing glasses, but still has double vision.
    Neuro-Optho is not sure why this happened. He does think it is odd, that his vision has changed so much.( Near perfect one and a half years earlier) He doesn't have an answer. He did say son does not have Horners.
    I was looking for answers...as usual. I was thinking csf leak, as this is one of symptoms. I did not realize this would happen shortly after injury.What else could it be, I just don't know? Maybe, its all just a coincidence.
    Maybe its related to autonomic dysreflexia.??? Who knows. We go back to Urologist on 25th, regarding him being unable to urinate except when bladder is very full.
    (Once per day approx.)
    The funny thing is that he has had two episodes of this. Which is usually seen in injuries above t6. His highest documented injury is t5.( I just keep coming back to cervical area)
    Very frustrating.
    I sure hope his vision just gets better.
    We are to go to downey rehabilation soon. So... I guess, I just cross my fingers, for answers.
    Thank-you ,
    so much!
    Diana
    Diana,

    I guess the neuro-opthalmologist is not being very helpful. You can do the examination yourself. The following are some steps in determining whether the problem is associated with the eyeball itelf or one of the ocular muscles.
    http://www.jeffmann.net/NeuroGuidemaps/diploplia.html

    1. Have you son cover the left eye and look at your finger with his right eye. Is he still seeing double? If not, have him cover the right eye and look at your finger with his left eye. Is he seeing double? If he has diplopia with one of his eyes, this is called monocular diplopia and suggests a problem with that eye and it is not a neurological problem.
    2. Does his diplopia get worse when he is tired? Are there any associated symptoms of droopy eyelid, proximal muscle weakness? If so, this may be a muscle problem, such as myasthenia gravis.
    3. Is his glassses correct? Can he read newpaper text held two feet from his face? If one of his eyes changed, this would cause diplopia.
    4. Is the ghost image horizontally or vertically related to the main image? In other words, are they side-by-side, top-bottom, or oblique. The former is called horizontal diploplia and is a result of weakness of the medial or lateral rectus eye muscle of one of the eyes. The latter is called vertical diplopia or oblique diplopia and is due to weakness of the other eye muscles.
    5. Does tilting the head worsen or improve the diplopia? A vertical or oblique diplopia that worsen with tilting the head suggests a weakness of the contralateral fourth cranial. Contralateral refers to side opposite of the tilt direction.
    6. Does looking to the right or to the left make the diplopia worse? This would be consistent with weakness of the lateral or medial rectus muscles.
    7. Is the diplopia worse when looking at something far away or near? Lateral rectus weakness generally worsens diplopia at a distance.


    I paraphrased some of the instructions. There is more.

    Wise.
    Last edited by Wise Young; 02-23-2008 at 10:08 AM.

  10. #10
    Quote Originally Posted by uuudianauuu
    Dr. Wise,
    I am wondering....as usual, Obviuosly I am a bit...obsessed with answers. Possibly, likely... obsessive compulsive disorder.(lol)
    My father is pretty much an inventor, engineer, etc. He has a photo graphic memory ( I was not blessed with this). He steers towards electronics. He was the one that invented underwater voice communication. Before him, you could not talk underwater. I don't know alot about him. He is living in Sacramento now.I was not raised by him. But, I do know he would do anything for his children.
    He did not grow up the normal way. (Orphan), At 15 he went to Korean war, he became a radio ham operator..someone took an interest in him.
    He never did anything medically, that I am aware of. But, I do know he did something with the goverment in geologics, and later something to do with vibration and friction etc. He worked for General Dynamics for years (he had his own lab). He also is above and beyond in math, computers etc. I read an article he wrote on something to do with boat engines( a hobby, at the time ), using simple algebra. (not simple, for the average person) He has dipped into much more than I am mentioning. ( I just googled him, and now he is apparently doing something with meteor electrophonics)He is one of these people that are far above the norm regarding IQ.
    I am wondering...how brilliant are you? I am thinking quite brilliant. But, am very curious, about what drives you....are you like my father...so above and beyond smart? ( I know this sounds like an odd question, but I happened to cross paths with an engineer, Professor,(CAL POLY POMONA) who is working on a cure for Aids.(AFRICA) He also wrote a book on vibration, in air space. He had heard of my father, and told me he wished he could get people like him in one room.)
    The cord is like the wiring in electronics, right? ( With the exception, I am thinking...we are not wired identically)
    My father is getting up in years, but...still dips into various subjects. Can I ask him to help you in anyway?
    ( sorry, I know this is out there. But he really is above the norm. I did not in-herit his IQ. But, I do believe I inherited his curiousity.)
    Diana
    Diana,

    You sure seems to have inherited your father's inquisitiveness. I suspect that your IQ is not that different from his. Anyway, intelligence is over-rated, in my opinion. IQ is like strength or height. It is useful to be strong and tall but not always what you need to get where you want to go. You have that very special characteristic of open-mindedness and desire to understand. Does your son have this? I think your father would enjoy the problem of diagnosing your son's dipolopia.

    Wise.

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