PMR/6th Cranial Nerve Palsy

[Kshelsmi]

Has anyone experienced 6th cranial nerve palsy? I was diagnosed with it about a year ago, and it resolved itself within a few months. I noticed a few weeks ago I was getting those symptoms again (double vision in distance but not close up). This condition can be caused by inflammation, so I upped my prednisone dose from 2 to 20mg, and it seemed to help. I have tapered back down to 3.5mg, and the vision issues don’t seem to have gotten worse again. I was wondering if the inflammation could be related to my PMR. Anyone else experienced this? I can ask my rheumatologist at my January appointment, but I thought I’d throw it out there in case someone else has had a possible PMR-related 6th cranial nerve palsy. Sorry this is a little long and rambling.

[SheffieldJane]

No your post is perfectly clear.My instinct is that you should receive medical attention/advice before January. With PMR there is always the very real risk that Giant Cell Arteritis may develop and this should always be treated as an emergency. However familiar these symptoms seem, they could also point to GCA which poses a very real risk of sudden loss of eyesight. I urge you to obtain medical advice!

[jinasc]

Take a look at this link:

link.springer.com/epdf/10.1...

[PMRpro Ambassador]

Any cranial nerve can be affected in GCA - and I checked:

reviewofoptometry.com/artic....

reviewofoptometry.com/artic....

I really don't think it can be discounted that the PMR and your 6th nerve palsy are connected. If the visual symptoms reappear I think you need to speak to the rheumy asap. Given the likelihood of that happening in the next 2 weeks, where is your nearest LARGE A&E with rheumy and eye departments?

[123-go]

Hi, Kahelsmi. I don't know that you really need all the following information but I'll relate my experience. I developed double vision with slight headaches and rising CRP in November 2019. I contacted my consultant's secretary and was referred to the rapid access clinic where I was examined by the hospital ophthalmologist and later given an ultrasound scan which showed progressive 6th nerve palsy and my steroid dose was increased. I was given a prism for my glasses on the same day and this reduced in strength over a period of four months until I no longer needed it. Also in December that year I had an MRI brain scan which showed 'unremarkable appearances of brain and intercranial arteries'.

As in comments below you MUST report double vision to your doctor/rheumatologist: don't leave it in the hope that it will go away on its own. A call to 111 (as it's the weekend) explaining your symptoms and possible consequences of a delay in prompt investigations should result in a call from a doctor who will advise you. Don't be alarmed but be safe.

[Kshelsmi]

Thank you, all, so much for your responses. When this happened the first time, GCA (or a stroke) did occur to me. I had an MRI done, which was normal. I wound up seeing a neuroophthamologist who gave me the 6th cranial... diagnosis. I also had an ultrasound of my temples to rule out GCA. Since the vision issues match exactly the 6th cranial... symptoms and I don’t have any other GCA symptoms (head/jaw pain), I am confident that’s not the issue. 123-go, I appreciate your confirmation that the inflammation could be PMR related. I will take to heart everyone’s advice to be seen sooner rather than later.

[membership]

I would suggest you seek help immediately, rather than wait for the symptoms to reappear. I had sudden onset double vision; a visit to my GP was a complete waste of time, but my optician was on the ball... he sent me immediately to Eye A&E. Biopsy confirmed GCA with Cranial VI paralysis, but I had the good fortune to be allocated to a fantastic Rheumy (LD at RHH, Sheffield). I began on 60mg pred., tapering slowly.. a couple of bumps so far, but otherwise I just have the steroid side-effects to contend with. My sight, which was at risk, was saved....I might be a bit of a dumpling, but I am so grateful to those who have helped me... and my hair is now curly ! Do seek help now; damage to your sight cannot be repaired.

[Kshelsmi in reply to membership]

Thank you for your reply, membership. I will contact my rheumatologist tomorrow. I appreciate you sharing your experience; glad it was caught and you are doing better.

[membership]

Good luck... be forceful if necessary... it is important !