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What Causes A Sudden Onset Of Double Vision?
Question: What would causesudden onset double vision, improved with one short course of prednisone, now worse after about two months and a new symptom of sudden tongue swelling at odd mements, now seems permanent, and now inability to swallw.
Brief Answer:
Vasculitis/Hypothyroidism. Please upload documents.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar, a neurologist, here to answer your query.
If your fiancée would had presented to me as an outpatient with such a medical history, my clinical explanation would have been-
Sudden onset diplopia responding to a short course of steroids might have occurred due to a number of causes as: transient corneal or lens inflammation, hypothyroid myopathy, diabetic cranial neuritis, idiopathic cranial neuritis, myaesthenia gravis (unlikely here as symptom did not recur), head injury(likely no such history here), pontine stroke, intracranial aneurysm, idiopathic intracranial hypertension or hypotension or vasculitis among the common ones.
Tongue swelling with diplopia shortens the list to the following causes: Vasculitis (amyloidosis), hypothyroidism.
In presence of episodic tongue swelling initially, possibility of allergy to any external agent has to be considered.
For now, since MRI Brain was normal, I would like you to get the following investigations done:
CRP, ESR, ANA, serum ACE levels, Thyroid function tests, blood sugar (fasting and post prandial).
Meanwhile, please take an ophthalmologist's opinion for the past history of diplopia and start taking multivitamins tablets on a regular basis. If tongue swelling do not resolve, and hypothyroidism is not a cause, we can plan to investigate for amyloidosis.
Please upload the document showing physical examination findings noted by the neurologist at the time of diplopia.
Hope I have answered your query for now. If you have follow up questions, I shall be glad to answer.
Dr.Ajay Panwar,
MD,DM (Neurology)
Vasculitis/Hypothyroidism. Please upload documents.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar, a neurologist, here to answer your query.
If your fiancée would had presented to me as an outpatient with such a medical history, my clinical explanation would have been-
Sudden onset diplopia responding to a short course of steroids might have occurred due to a number of causes as: transient corneal or lens inflammation, hypothyroid myopathy, diabetic cranial neuritis, idiopathic cranial neuritis, myaesthenia gravis (unlikely here as symptom did not recur), head injury(likely no such history here), pontine stroke, intracranial aneurysm, idiopathic intracranial hypertension or hypotension or vasculitis among the common ones.
Tongue swelling with diplopia shortens the list to the following causes: Vasculitis (amyloidosis), hypothyroidism.
In presence of episodic tongue swelling initially, possibility of allergy to any external agent has to be considered.
For now, since MRI Brain was normal, I would like you to get the following investigations done:
CRP, ESR, ANA, serum ACE levels, Thyroid function tests, blood sugar (fasting and post prandial).
Meanwhile, please take an ophthalmologist's opinion for the past history of diplopia and start taking multivitamins tablets on a regular basis. If tongue swelling do not resolve, and hypothyroidism is not a cause, we can plan to investigate for amyloidosis.
Please upload the document showing physical examination findings noted by the neurologist at the time of diplopia.
Hope I have answered your query for now. If you have follow up questions, I shall be glad to answer.
Dr.Ajay Panwar,
MD,DM (Neurology)
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
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