Third nerve palsy and PMR

[Fishponds50]

In November 2018 I developed double vision and the ophthalmologist via A&E diagnosed third nerve palsy and said it would correct itself despite me telling her all about my other symptoms (classic PMR in retrospect). The next day I already had a GP appointment and he after previous blood tests etc had already decided that I likely had PMR and prescribed 20 mg predisolone. This was increased to 30 mg the next week. I am currently tapering to 13 mg at present. I’ve read about PMR and GCA but not third nerve palsy. Does anyone else have experience of this?

[Hidden]

Hi fishponds50, I don't know anything about third nerve palsy but googled and there do seem to be discussions regarding palsy and GCA. I can't access the full papers but they are obviously mentioned in the same breath. Hopefully someone will come along that is able to be a bit more helpful. 🌻

[JakeSearcher]

Well, incredibly, I was just getting ready to post about my bad news regarding third nerve! Yesterday I saw the neuro-ophthalmologist. He showed me my MRI. This is in the report: "abnormal soft tissue in the left cavernous sinus and orbital apex likely in close association with the left oculomotor nerve." (third nerve). And I could see when he showed me the picture how my right space was all dark but my left space had the white in it. Whatever is there, is alongside my third nerve. This is why I have the drooping eyelid and my left eye does not go all the way up. And since the eyes don't work together I get double vision when I look a certain way. Now he needs an MRI with contrast to see what that soft issue is that is pressing on the nerve. And I gingerly asked about surgery and he said, yes, but let's not talk about that yet. I was sort of shocked by all this. On my own I have been reading up and I did see something about steroids causing a fatty deposit in this area. But I guess I will have to get the MRI with contrast. He also did a complete eye exam and everything else was normal. But this was not a good afternoon.

[Fishponds50 in reply to JakeSearcher]

Sorry to hear your news. I wasn’t on steroids at the time third nerve palsy was diagnosed but I have long term sinus problems. Take care.

[JakeSearcher in reply to Fishponds50]

I was diagnosed with 3rd nerve ten years ago but only slight droopiness and no real sight problems. That is, until recently, when PMR and pred came along. Hard to believe there is no connection.

[Fishponds50 in reply to JakeSearcher]

Absolutely - my GP thinks there is but ophthalmologist wouldn’t make the connection. I can’t believe it’s a coincidence in my case.

[PMRinsdca]

Hi,

My son was home from college, several years back, went to bed with a migraine headache and woke up with double vision. It was really scary, he was only 19 yrs old and they thought perhaps he had a stroke. After MRI's, CATscans, eye exams, etc., the neuro-opthamologist diagnosed him with Third Nerve Palsy, saying the nerve got pinched during his migraine. The double vision took several months to go away. He was fortunately able to go back to school. (BTW I have PMR and GCA so I hope this isn't going to run in the family!)

Fishponds50... did you have a headache at all before the double vision started?

Best wishes for speedy recovery!

[Fishponds50 in reply to PMRinsdca]

Yes I did - a terrible one for a few weeks beforehand taking painkillers every 4 hours. It all started I believe with a bad sinus infection. At that time they hadn’t diagnosed PMR. So sorry to hear about both you and your son. Hope he’s ok with no lasting ill effect to his vision?

[PMRinsdca in reply to Fishponds50]

He is fine. Thanks. There were no lasting issues with his vision, thankfully. His doctor did say that it would gradually go away within several months, which it did.

Did they check you for GCA, or bring that up because of your headache and double vision? Has your vision improved since being on the Pred?