Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Gamma Knife Treatment for Lost Vision

Forum: Neurology Forum
Topic: Lupus

Re: Gamma Knife Treatment for Lost Vision

Re: Gamma Knife Treatment for Lost Vision

Posted by ccf neuro M.D. on April 24, 1997 at 14:25:57:

In Reply to: Gamma Knife Treatment for Lost Vision posted by Kathleen K. on April 15, 1997 at 08:36:55:

: Dear Cleveland Clinic Staff,

I am a 38 yr old Lupus patient living in Montreal, Quebec, Canada.
I have progressive severe tunnel vision as charted on repeat visual
field tests performed over the past two years. The problem causing the
visual field defect is not my eyes,or from taking plaquenil, but stems
from cns inflammation affecting the occipital lobe. I also have poor
cognitive function and memory, and many other lupus manifestations.

I am awaiting an appointment for a MRI and an neurology consult here in
Montreal. I am taking the immunosuppressives - prednisone and imuran
and yet my vision worsens. I have not exhausted my treatment options
here in Montreal, but am discouraged.


The "gamma knife" is a device that focuses many radiation beams to all converge on a single point in space, much like the way a lens focuses rays of light onto a single point in space. It is thus used to treat very focal lesions in the brain like tumors or vascular malformations. Lupus wqhen it affects the brain may cause inflammation of the blood vessels, called vasculitis, which can result in many small (or sometimes large) strokes in the areas of the brain affected. This is a very serious and tough to treat problem. Immunosuppressant medications are the treatment of choice, although presumably by now you,ve had a spinal tap (lumbar puncture) to be certain you do not have an INFECTIOUS disease, like chronic meningitis caused by one of several fungal organisms that can infect immunosuppressed people, that may mimick this problem, but are treated very differently (with fungal antibiotics), since immunosuppressants worsen such infections. If you live in Montreal, you are fortunate in that one of the finest
neurologic institutes in North America, McGill, is near you. A neurologist there would certainly be able to perform all the appropriate tests (possibly including a brain biopsy--- don't cringe--- it's much more benign than it sounds, and/or an angiogram of the brain blood vessels) to give you a definite diagnosis and the best possible treatment. The gamma knife has no legitimate role in treating vasculitis or lupus.

Could there be any benefit to the gamma knife in my situaion? Is there
any other treatment at the Cleveland Clinic that could help me to
restore the vision I have lost, or at least halt it from progressing.

I would appreciate anything that you may be able to do to help me.
Please e-mail me for any information you might need to further assess my
situation.
Sincerely,
Katherine K.
Dorval, Quebec, Canada
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