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Can A Cranial Nerve Palsy Patient Have Normal Eye Movements?

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Posted on Fri, 22 Apr 2016
Question: Hi XXXXXXX
If I have A 3 4 OR 6 Cranial Nerve Palsy or muscle paralysis/ weakness ? Would the eye still move through its normal eye movements?
doctor
Answered by Dr. Ajay Panwar (59 minutes later)
Brief Answer:
It should not unless the palsy is very subtle.

Detailed Answer:
Hi Cfirstcc,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

3,4 and 6th cranial nerves innervate the extraocular eye muscles which are responsible for eye movements in all directions.

So,either of these cranial nerve palsies,will impair eye movements,unless the palsy is very subtle, which does not result in obvious ocular movement impairment.

Hope this helps.If you have further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (39 minutes later)
Head tilt to the right (aggrivates) the diplopia
if I have a superior oblique muscle weakness should that be the opposite ie makes the diplopia better

What is another explanation for my binocular vision.In my case
If one had Diabetes,would that cause binocular vision with no blurring of vision and no obvious restriction of eye or eye lid movement.
Also given relatively rapid onset of signs and symptoms
doctor
Answered by Dr. Ajay Panwar (24 minutes later)
Brief Answer:
YES.

Detailed Answer:
Hi Cfirstcc,
Thanks for being in follow-up.

In case of superior oblique palsy, tilting the head towards the opposite(unaffected) side, makes the diplopia better and tilting the head towards the same side(on the side of weakness of superior oblique),diplopia gets worse.The logic is simple,separation of image increases while tilting on the same side and hence the diplopia;and vice versa.

I hope you got the point.If you have some further questions,I shall be glad to answer them.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (3 hours later)
SO DIPLOPIA INCREASES WHEN TILTING HEAD TO THE RIGHT SO IF THAT IS THE CULPRIT THEN IT IS THE RIGHT SUPERIOR OBLIQUE IS THE PROBLEM AND NOT THE LEFT???
doctor
Answered by Dr. Ajay Panwar (8 minutes later)
Brief Answer:
Precisely.

Detailed Answer:
Hi Cfirstcc,
Thanks for being in follow-up.

Of course,that's what it is.

Hope this helps.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (4 minutes later)
ANOTHER THOUGHT
WAS TAKING A ANTI DEPRESSANT APO ESCITALOPRAM 10MG
IT HAS A POTENTIAL TO CAUSE DOUBLE VISION,HOW DO OR HOW CAN ONE RULE THAT OUT AS A CAUSE
REGARDS XXXX

JUST FOR INTEREST HOW DO YOU GET PAID FOR THIS SERVICE
THANK YOU FOR YOUR THOUGHTS ON MY MATTER
doctor
Answered by Dr. Ajay Panwar (19 hours later)
Brief Answer:
Diplopia is rare with escitalopram.

Detailed Answer:
Hi Cfirstcc,
Thanks for being in follow-up.

Diplopia is not at all common association with escitalopram. It has been extremely rarely reported.Its mechanism is not very clear.Besides,it does not cause extraocular palsy.
Vertical diplopia with improvement on head tilt, is specific to extraocular muscle(superior oblique) weakness.This finding will not be seen in escitalopram induced diplopia.
Payment is fixed per query.

Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (52 minutes later)
still do not get your comment

1.lateral head tilt to the right aggrivates the diplopia
which sup obliq muscle do you think is the culpret right or left,

2.fracture to wall of orbit 2006
could that be a cause

summary
AGE 59 MALE
2006
ONE PUNCH LA FORTE 2 FRACTURE 2006
PLATE INSERTED UNDER LEFT EYE BALL IN 2006 TO STABALIZE FRACTURE
THE PLATE UNDER LEFT EYE WAS SPLINTERED WITH PIECES GOING INTO LEFT SINUSES HAD PIPLOPIA AT THE TIME
2006 MVA
2008 3 MVAS WHIPLASHES
2012 SLIP FALL HURT RT ANKLE TORE STRAINED SPRAIN LIGS SORE BACK
2012 GOT A HIT IN FACE BY ACCIDENT TWISTED LEFT EYE PLATE DEVELOPED LATERAL DIPLOPIA HAD IT EVER SINCE
REMOVED LEFT EYE PLATE
2014 MVA WHIPLASH
2015 EARLY HAD A ASSAULT HURT BACK NECK AGAIN 2 DISC PROLAPSES C56-AND C67
2015 AUGUST MVA MY CAR STATIONARY LOW SPEED BUT GOOD GOLT SAUSED LOTS OF HEADACHES
LATE 2015 STARTED TAKING ANTI DEPRESSANTS APO ESCITOPHAM 10 MG
TOLD DOCTOR OCT 2015 NOTICED CHANGE BLURRING OF VISION MEDIUM DISTANCE AT FOOT OR AT CEILING DISTANCE SHORTLY AFTER HAD FALL DOWN STEPS DUE TO BLURRING ,COULD NOT MAKE STEPS OUT AND UN STABLE RIGHT ANKLE BAD FALL 2 LUMBAR DISC INJURIES AND BAD LEFT ANKLE GRADE 2 STRAINS
STARTED TAKING LYRICA DUE TO BACK LEG PAIN
APPROX 2.5 MONTHS LATER GOT DOUBLE CENTRAL VISION
AGGRIVATED BY RIGHT LATERAL HEAD TILT AND ROTATION OF HEAD INC EXTENSION OF HEAD
DOUBLE FROM APPROX MID LINE AND DOWN WORSE LOOKING AT FEET. THINGS GET FURTHER APART
DIPLOPIA IS ABOVE AND BELOW VERTICAL?
STEPS ARE DOUBLE AND TWISTED AT A ANGLE
ONE EYE CLOSED REDUCES DIPLOPIA BILATERALLY
BLOOD TEST INC THYRIID OK GLUCOSE 20 JUST HAD A WATER MELON BEFORE TESTING AT HOSPITAL
NORMALLY 10 -12
EYE CLINIC SAID NERVE PALSY?
WENT TO PRIVATE NEUROLOGIST SAID CAUSE NOT NEUROLOGIC OR DIABETES RELATED

PLEASE NOTE ALL MVAS NOT MY FAULT
ALL 3 PARTY
ALSO HAVE GOOD VISION NOT BLURRING ,AT A DISTANCE BETTER THAN 20/20 . JUST CLOSE UPS
PUPILS SAME SIZE
ALL MOVEMENTS OF EYES POSSIBLE IN ALL DIRECTIONS
NO EYE LID DROPPING
CT AND MRI CLEAR
NO OBSTRUCTION TO TROCHLEAR NERVES ALL GOOD SO RADIOLOGIST SAY?FIELD OF VIEW TESTS SAY NO PRESSURE FROM TUMOE BLOOD VESSEL ETC
Asked by Me , 2 hours ago
RECENTLY HAD SINUS INFECTION TOOK ANTIBIOTICS
Asked by Me , 2 hours ago
BLOOD AND EYE PRESSURE GOOD
Asked by Me , 2 hours ago
Doctor's reply to your question above...
Brief Answer:
Possibility of ocular cause of diplopia

Detailed Answer:
Hello,
Reviewed your history.
According to me the reason for your diplopia especially vertical is ocular due to fracture orbital wall and disturbed dynamics of eye movements.
The Mri brain is normal so possibility of any nerve involvement in the path to eyes is unlikely.

finally what do you think is the cause of diplopia
regards XXXX
doctor
Answered by Dr. Ajay Panwar (15 hours later)
Brief Answer:
Please clarify the following.

Detailed Answer:

Hi Cfirstcc,
Thanks for being in follow-up.


You mentioned that in


'2012 GOT A HIT IN FACE BY ACCIDENT TWISTED LEFT EYE PLATE DEVELOPED LATERAL DIPLOPIA HAD IT EVER SINCE'

Then again you mentioned 'APPROX 2.5 MONTHS LATER GOT DOUBLE CENTRAL VISION'.

So,was it like the previous diplopia had improved and then 2.5 months later you again developed diplopia?

I mean,since when are you having this vertical diplopia?


Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Ajay Panwar

Neurologist

Practicing since :2007

Answered : 1827 Questions

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Can A Cranial Nerve Palsy Patient Have Normal Eye Movements?

Brief Answer: It should not unless the palsy is very subtle. Detailed Answer: Hi Cfirstcc, Thanks for being on healthcaremagic.com. I am Dr.Ajay Panwar,a neurologist,here to answer your query. 3,4 and 6th cranial nerves innervate the extraocular eye muscles which are responsible for eye movements in all directions. So,either of these cranial nerve palsies,will impair eye movements,unless the palsy is very subtle, which does not result in obvious ocular movement impairment. Hope this helps.If you have further questions,I shall be glad to have you in follow-up. Regards Dr.Ajay Panwar, MD,DM(Neurology)