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suddenly cross-eyed

 
 
Mr. X
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Posts: n/a

 
      12-07-2004, 03:47 AM
Hello,

May I please solicit some advice?

(first a detailed background and then 2 questions)

On Saturday morning, my daughter (2 years, 9 months) suddenly woke up...
cross-eyed.

We have been to a doctor and an opthamalogist, and will see them again
in a few days, but I would like further input if it is possible, please.

There are two other issues:

1) at the age of 9 months, she fell from her crib and fractured her skull.
There was slight bleeding above the perineurium and beneath the skull.
But all healed on its own.
There was never any fainting, vomiting or any symptom.
She has been fine since.

2) on friday night (night before she woke up cross-eyed), she and I were
playing games staring into each other's eyes (basically, going
deliberately
cross-eyed.

The opthamalogist said that my daughter is slightly far sighted (unlike me
who is very near sighted), and the far sightedness is asymetrical. In such
cases, children try to compensate (hence the cross-eyed), and that it is
remotely possible that our cross-eye game the night before might have kicked
it in (but that I should not feel bad, I did not cause this, and it would
have
happened eventually).

Well the doctor wants us to get glasses for a few days, and if it all clears
up... likely that was it... if not... a CAT scan.

Now my wife's friend - who has good intent - has just told me:
1) It should be an MRI not a CAT scan.
2) the analysis above does not hold water... does not make sense
3) There may be damage to the sixth cranial nerve.

OK... could I have some comments please.
I am worrying and would like to calm down.

Please do not email... I get much junk email. Please respond to the
newsgroup.
Or email to:
http://www.optometryforums.com/(E-Mail Removed)

Thank you,
Tom



 
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LarryDoc
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      12-07-2004, 05:22 AM
In article <yH9td.398202$a85.200265@fed1read04>,
"Mr. X" <(E-Mail Removed)> wrot
> On Saturday morning, my daughter (2 years, 9 months) suddenly woke up...
> cross-eyed.
>
> We have been to a doctor and an opthamalogist, and will see them again
> in a few days, but I would like further input if it is possible, please.
>
> There are two other issues:
>
> 1) at the age of 9 months, she fell from her crib and fractured her skull.
> There was slight bleeding above the perineurium and beneath the skull.
> But all healed on its own.
> There was never any fainting, vomiting or any symptom.
> She has been fine since.
>
> 2) on friday night (night before she woke up cross-eyed), she and I were
> playing games staring into each other's eyes (basically, going
> deliberately
> cross-eyed.
>
> The opthamalogist said that my daughter is slightly far sighted (unlike me
> who is very near sighted), and the far sightedness is asymetrical. In such
> cases, children try to compensate (hence the cross-eyed), and that it is
> remotely possible that our cross-eye game the night before might have kicked
> it in (but that I should not feel bad, I did not cause this, and it would
> have
> happened eventually).
>
> Well the doctor wants us to get glasses for a few days, and if it all clears
> up... likely that was it... if not... a CAT scan.
>
> Now my wife's friend - who has good intent - has just told me:
> 1) It should be an MRI not a CAT scan.
> 2) the analysis above does not hold water... does not make sense
> 3) There may be damage to the sixth cranial nerve.
>
> OK... could I have some comments please.
> I am worrying and would like to calm down.


It is certainly possible that your ophthalmologist's assessment is
correct. She may have a simple over-convergance due to farsightedness
and/or a muscle spasm, but especially considering her history, there is
also the possibility of other causes for the condition and hence the
discussion of CAT scan or MRI scan.

Try to observe her eyes as she awakens from sleep and before she looks
at a close object. If her eyes are not crossed at that time, and do
cross when she looks directly at you, your worry level should come way
down. If, on the other hand, her eyes are significantly crossed upon
awakening, or if you observe any other unusual condition or behavior,
consider this to be a condition warranting immediate attention.

If further testing is required, the protocol would be to first perform a
cycloplegic refraction to determine the extent of the farsightedness,
which would also cause the eyes to uncross. Perhaps the doctor can
provide plus lenses and see if the eyes uncross. That might yield the
answer right there. And again, the worry level goes way down

If not, the next step would be an imaging of the brain. Some docs might
prefer the CAT scan because it is quicker and would not necessarily
require sedation or if so, less so than an MRI. But for a child, you
must way the risks and benefits. The CAT scan exposes her to a certain
amount of radiation, and is not as good a diagnostic tool, but it is
faster. The MRI takes longer to do, would likely require her to be
medicated and sedated, but will yield a better picture and perhaps an
easier diagnosis.

So don't worry too much yet, but do proceed immediately with further
testing and if there is any doubt of how the doctor is proceeding, do
consider a second opinion. And remember, that although you did provide a
reasonable presentation of the issues, advice given here is based on
that, and not on actually examination in person.

I hope that the answer is simple and she will be fine, Do let us know
how this works out.

--LB. O.D.
 
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Scott Seidman
Guest
Posts: n/a

 
      12-07-2004, 01:42 PM
"Mr. X" <(E-Mail Removed)> wrote in news:yH9td.398202$a85.200265
@fed1read04:

> Now my wife's friend - who has good intent - has just told me:
> 1) It should be an MRI not a CAT scan.
> 2) the analysis above does not hold water... does not make sense
> 3) There may be damage to the sixth cranial nerve.
>
> OK... could I have some comments please.
> I am worrying and would like to calm down.
>
> Please do not email... I get much junk email. Please respond to the
> newsgroup.
> Or email to:
> (E-Mail Removed)
>
> Thank you,
> Tom
>
>
>
>


Tom-

First, your cross-eyed game has nothing to do with this.

Second, you seem understandably concerned. I think that with your
daughters history and the apparent sudden onset (as others have pointed
out, this may have been there for awhile, and you just noticed it), a
referral to a pediatric neuroophthalmologist--preferably, one who
received most of his training on the neurology side, but any peds
neuroophth should do-- is not out of order. If it were my daughter, I'd
make sure this happens, mostly because I'm a worrier and that would calm
me down. In fact, if it comes down to MRI, I'd definately want a
neurologist or neuroophth to do the requesting, because that type of doc
might want a specific type of image that others might not request, and
then you'd just have to repeat the MRI, which isn't necessarily easy with
a three year old. If I couldn't get a referral, I'd be tempted to pay
out of pocket (my guess would be in the $300 neighborhood), but this
might cause problems with getting your insurance to cover any expensive
imaging and other diagnostic testing.

Last, I've got no medical training. This is just what I'd do if it were
my own daughter.

Good Luck
Scott
 
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g.gatti@agora.it
Guest
Posts: n/a

 
      12-07-2004, 05:40 PM
Another wonderful case!

Why don't you try again to play cross-eyed so that you may increase the
strain and let it then disappear?

Also, you can try to swing your child, either in your arms or on a
swinging chair or on a swing in the park under the sun.

It should be interesting to ask to the doctor what has the six cranial
nerve to do if the inception of the cross-eyed condition just happened
after having done some exercises in straining the eyes to see at the
very near point?

I am interested in this case if the parents are willing to follow rest
methods treatments as taught bt Dr. Bates in the book Stories From The
Clinc, where they have reported many cases like this resolved in few
days.

 
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Mr. X
Guest
Posts: n/a

 
      12-08-2004, 01:45 AM
HELLO!

I am the dad in this case.
here is a picture of my daughter one week before
http://kahuna.sdsu.edu/~impellus/sofia/sofia.html

PLEASE CONTACT ME AND EMAIL WHAT INFORMATION YOU MIGHT WISH!!!!

Please.. I am bit anxoius

Tom Impelluso
(*MY* mom is from Bari and my dad is from Syracus by the way)


<(E-Mail Removed)> wrote in message
news:(E-Mail Removed) oups.com...
> Another wonderful case!
>
> Why don't you try again to play cross-eyed so that you may increase the
> strain and let it then disappear?
>
> Also, you can try to swing your child, either in your arms or on a
> swinging chair or on a swing in the park under the sun.
>
> It should be interesting to ask to the doctor what has the six cranial
> nerve to do if the inception of the cross-eyed condition just happened
> after having done some exercises in straining the eyes to see at the
> very near point?
>
> I am interested in this case if the parents are willing to follow rest
> methods treatments as taught bt Dr. Bates in the book Stories From The
> Clinc, where they have reported many cases like this resolved in few
> days.
>



 
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David Robins, MD
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Posts: n/a

 
      02-21-2005, 07:38 AM
Sudden crossing DOES make sense in cases where it si accommodatie esotropia
caused by farsightedness. I see this frequently. Your friend's analysis that
it does not make sense may be wrong.

6th nerve paralysis is obvious. One eye will not be able to a abduct all the
way,a nd the eye crossing will be markedely different on right vs left gaze.
Should be obvious to the experienced ophthalmologist if it were 6th nerve.

Could be neurological, and if one were looking, yes, an MRI, not a CT, is
indicated. CT is not very good for neurological problems. However, a tumor
would be extremely rare, as would be an aneurysm or AV malformation.. The
issue of the old skull fx is probably too distant past to have relevance to
this new finding.

The least invasive way to work this up is order the glasses, and if it
resolves the crossing, no further workup is indicated. Note that an MRI at
this age would have to be done under heavy sedation to eliminate movement.



On 12/6/04 7:47 PM, in article yH9td.398202$a85.200265@fed1read04, "Mr. X"
<(E-Mail Removed)> wrote:

> Hello,
>
> May I please solicit some advice?
>
> (first a detailed background and then 2 questions)
>
> On Saturday morning, my daughter (2 years, 9 months) suddenly woke up...
> cross-eyed.
>
> We have been to a doctor and an opthamalogist, and will see them again
> in a few days, but I would like further input if it is possible, please.
>
> There are two other issues:
>
> 1) at the age of 9 months, she fell from her crib and fractured her skull.
> There was slight bleeding above the perineurium and beneath the skull.
> But all healed on its own.
> There was never any fainting, vomiting or any symptom.
> She has been fine since.
>
> 2) on friday night (night before she woke up cross-eyed), she and I were
> playing games staring into each other's eyes (basically, going
> deliberately
> cross-eyed.
>
> The opthamalogist said that my daughter is slightly far sighted (unlike me
> who is very near sighted), and the far sightedness is asymetrical. In such
> cases, children try to compensate (hence the cross-eyed), and that it is
> remotely possible that our cross-eye game the night before might have kicked
> it in (but that I should not feel bad, I did not cause this, and it would
> have
> happened eventually).
>
> Well the doctor wants us to get glasses for a few days, and if it all clears
> up... likely that was it... if not... a CAT scan.
>
> Now my wife's friend - who has good intent - has just told me:
> 1) It should be an MRI not a CAT scan.
> 2) the analysis above does not hold water... does not make sense
> 3) There may be damage to the sixth cranial nerve.
>
> OK... could I have some comments please.
> I am worrying and would like to calm down.
>
> Please do not email... I get much junk email. Please respond to the
> newsgroup.
> Or email to:
> (E-Mail Removed)
>
> Thank you,
> Tom
>
>
>




 
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David Robins, MD
Guest
Posts: n/a

 
      02-21-2005, 07:44 AM
A radiologst knows what to order for sudden neurological eye crossing -
looking at the 6th nerve area of the brain and the brainstem. A head MRI
covers all of this is all 3 planes.

A head MRI is more like about $3000 at many places, not $30.

An MRI under sedation is much more expensive, and a 3 year old would require
that.

See the posting about testing for glasses and givinga short trail to see if
that is the answer; no invasive testing required. (Assuming no other
neurologic signs).



On 12/7/04 5:42 AM, in article
Xns95B85887944ACscottseidmanmindspri@130.133.1.4, "Scott Seidman"
<(E-Mail Removed)> wrote:

> "Mr. X" <(E-Mail Removed)> wrote in news:yH9td.398202$a85.200265
> @fed1read04:
>
>> Now my wife's friend - who has good intent - has just told me:
>> 1) It should be an MRI not a CAT scan.
>> 2) the analysis above does not hold water... does not make sense
>> 3) There may be damage to the sixth cranial nerve.
>>
>> OK... could I have some comments please.
>> I am worrying and would like to calm down.
>>
>> Please do not email... I get much junk email. Please respond to the
>> newsgroup.
>> Or email to:
>> (E-Mail Removed)
>>
>> Thank you,
>> Tom
>>
>>
>>
>>

>
> Tom-
>
> First, your cross-eyed game has nothing to do with this.
>
> Second, you seem understandably concerned. I think that with your
> daughters history and the apparent sudden onset (as others have pointed
> out, this may have been there for awhile, and you just noticed it), a
> referral to a pediatric neuroophthalmologist--preferably, one who
> received most of his training on the neurology side, but any peds
> neuroophth should do-- is not out of order. If it were my daughter, I'd
> make sure this happens, mostly because I'm a worrier and that would calm
> me down. In fact, if it comes down to MRI, I'd definately want a
> neurologist or neuroophth to do the requesting, because that type of doc
> might want a specific type of image that others might not request, and
> then you'd just have to repeat the MRI, which isn't necessarily easy with
> a three year old. If I couldn't get a referral, I'd be tempted to pay
> out of pocket (my guess would be in the $300 neighborhood), but this
> might cause problems with getting your insurance to cover any expensive
> imaging and other diagnostic testing.
>
> Last, I've got no medical training. This is just what I'd do if it were
> my own daughter.
>
> Good Luck
> Scott


 
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