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

Question Title: Papilitis and accompanying symptoms

Forum: Neurology Forum
Topic: Lyme

Re: Papilitis and accompanying symptoms

Re: Papilitis and accompanying symptoms

Posted by CCF Neuro MD on April 07, 1997 at 22:10:10:

In Reply to: Papilitis and accompanying symptoms posted by Jeff P. on April 07, 1997 at 22:08:54:

: This Message was posted by: Jeff P. - 3/28/97 11:56:33 PM

Message:
I was recently diagnosed with a papilitis in my left eye. A field defect was noticed and the nerve head inflammation was
discovered. It worsened over the next 2 weeks and an MRI was performed. It was negative with no sign of MS plaques. Sed
rate was 1.

A neuroophthalmologist diagnosed the condition as presumed anterior ischemic optic neuropathy. It has gotten slightly worse
over the next several weeks and the nerve head is finally stabilizing. The was no treatment suggested except to wait. The field,
meanwhile,has gotten worse. Pressure in the eye is 20, high normal. No treatment necessary.

The history: I'm a 43 year old male, healthy, normal weight. I got hit in the left side of my head (with an automatic door) 5 days
before the onset of the field defect. Occasional weakness in right hand since childhood (was told it was a pinched nerve).
Occasional (pressure induced?) paresthesias in the hands or legs noticed upon waking during the past 2 months. Seven months
ago, bit by some insect (we think a spider) which left a small ulceration on my left leg. Lyme's tests have been negative. For the
past 2 months have noticed an occasional feeling of a vibration (like a beeper set to vibrate) in my legs or elsewhere. Lasts a
few seconds and fades when I move about. Several episodes of difficulty raising arms (like wings -biceps-) over the past 2
years. And lately, I've been more tired and can feel a background quiver (like a shiver, but I'm not cold) after I get into bed. I
can also sense it if I sit very still...it's in the background.

I'm considering circulatory, neurological, vascular, muscular, ophthalmic problems now but until I got hit by the door, I didn't
feel anything was wrong. Now, I am losing vision in one eye with no treatment available and the stress and frustration level is
building.

Any suggestion on a direction to go would be greatly appreciated.

Jeff P.
Connecticut

Hello Jeff, thank you for using this forum. First you should know that the term "papillitis" refers to swelling of the optic nerve
head (which is that portion of the optic nerve which is visual on the funduscopic exam- the part of the eye exam when the
opthomologist looks at the back of the eye with his ophalmoscope) and so does not convey a specfic diagnosis. Many
diseases of the optic nerve can produce this picture. Your doctors seemed to have evaluated you very thoruoghly for the most
common causes. What is helpful in differentiating a disease process like multiple sclerosis from ischemic (lack of blood supply)
process, is the progression of symptoms at the onset of the problem. Ischemic optic neuropathy typically occurs suddenly and
the symptoms are maximal at its onset wheras optic nerve involvement in multiple sclerosis usually evolves over hours to days
(rarely weeks to months)and can be painful. Various other hints to differentiate these disease can be obtained through the
neuoroophthalmologic
examination. The fact that your MRI of the brain was normal tells your physician that at least you do not have a very active
form of multiple sclerosis. By itself a MRI of the brain does not exclude the possibility of multiple sclerosis. Your other
symptoms that you have been experiencing can be seen in a wide variety of disorders among which multiple sclerosis is one
possibility. Your symptoms of a feeling of a buzzer or shivering are not common symptoms that we hear about. However, this
can be seen in patient who have a tremor(or shaking) of their arms or legs and experience a symptom of "internal tremor"
without any outward signs of shaking. What we do commonly hear (and perhaps this is what you are experiencing) is
symptoms of a "shock-like" or lightening sensation down the spine especially on bending the neck. The compliants of weakness
of you shoulders and numbness of your hand and feet would make me concerned about a process affecting your cervical spinal
cord. Your doctors may consider a
cerival MRI as well as other test to complete your evaluation. You case obviously reqiures a careful evaluation by a neurologist
with an interest in neuroimmunologic disorders. We have a group of neurologist at the Cleveland Clinic located in the Mellen
center who are experts in this field.
If you and your doctors are interested in a second opinion you can call (216) 444-5559 or call 1-800-CCF-CARE and ask
for neuorology appointments. I hope this is of some help to you.



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