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What Do Pain And Pressure Near The Temple With Double Vision Indicate?
Posted on
Mon, 4 Sep 2017
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Mon, 4 Sep 2017
Answered on
Thu, 5 Oct 2017
Last reviewed on
Question : The biggest issue with the pain in the left temple, is the intense pressure that goes with it. The vomiting is controlled with meds.
The double vision had made it impossible to drive. we don't know what to do except go back to the hospital.
The double vision had made it impossible to drive. we don't know what to do except go back to the hospital.
Brief Answer:
Should return to the hospital.
Detailed Answer:
I read your question carefully and as well as the exchanges with my other colleagues.
It is obvious from your description that there is an involvement of the third cranial nerve which is responsible for eye lid and eye ball movements. That can happen due to lesions of the brainstem or along the course of the nerve. The most obvious cause would seem a stroke but you mention MRI to be normal, that should exclude stroke. In that case an inflammation along the nerve path, especially a region called sinus cavernosus should be considered, from infections, sarcoidosis, Tolosa Hunt syndrome etc. It is unclear if MRI has been with or without contrast administration as you do not upload reports, if not contrast MRI studying that region is necessary.
Bottom line is that those symptoms indicate a brain involvement. You should return at the hospital in my opinion (I am surprised he was discharged in that condition), consult with a neurologist in order to reach the bottom of it.
I remain at your disposal for other questions (but possibly uploading imaging report).
Should return to the hospital.
Detailed Answer:
I read your question carefully and as well as the exchanges with my other colleagues.
It is obvious from your description that there is an involvement of the third cranial nerve which is responsible for eye lid and eye ball movements. That can happen due to lesions of the brainstem or along the course of the nerve. The most obvious cause would seem a stroke but you mention MRI to be normal, that should exclude stroke. In that case an inflammation along the nerve path, especially a region called sinus cavernosus should be considered, from infections, sarcoidosis, Tolosa Hunt syndrome etc. It is unclear if MRI has been with or without contrast administration as you do not upload reports, if not contrast MRI studying that region is necessary.
Bottom line is that those symptoms indicate a brain involvement. You should return at the hospital in my opinion (I am surprised he was discharged in that condition), consult with a neurologist in order to reach the bottom of it.
I remain at your disposal for other questions (but possibly uploading imaging report).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Today my husband and I returned to the ER. After doing an MRA the conclusion was Sixth nerve palsy.
At least we know something.
Thank you for all your help.
At least we know something.
Thank you for all your help.
Brief Answer:
Thank you for the update.
Detailed Answer:
Thank you for the update.
As I said a MRI with contrast was necessary, good that it was done. I am still a little puzzled, 6th nerve palsy may cause double vision but not drooping of the eyelid, that is the third nerve ... but perhaps he was closing one eye to eliminate the double vision, the doctors there have the advantage of being able to examine him. Anyway if an isolated finding he should gradually improve.
Let me know if I can further assist you.
Thank you for the update.
Detailed Answer:
Thank you for the update.
As I said a MRI with contrast was necessary, good that it was done. I am still a little puzzled, 6th nerve palsy may cause double vision but not drooping of the eyelid, that is the third nerve ... but perhaps he was closing one eye to eliminate the double vision, the doctors there have the advantage of being able to examine him. Anyway if an isolated finding he should gradually improve.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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