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

Question Title: Optic Neuritis as symptom of ATM as well as MS?

Forum: Neurology Forum
Topic: Neurology - General


This BB and the doctors responding have been really invaluable in providing good, clear ino., especially in situations where our own neuros are puzzled. In November of 1997, I was hospitalized with sudden lower body paralysis, loss of bowel/bladder control, positive Babinski, positive deep tendon reflexes, negative spinal and brain MRI's, evidence of spinal demylination, etc. One week prior to hospitalization, I had complained of weakness and just not feeling well. Blood test showed B12 deficiency and pernicious anemia. A year earlier I had had gastroplasty surgery for weight reduction. Three months prior to paralysis I had complained to my Internist of lower back tingling and later on, an area of numbness in the lower back. This was dismissed as probably a "pinching nerve" since tingling was only in pm.

Anyway, In addition to the paralysis, I also found that I had no desire to watch TV or read, but I would not characterize the vision problem as "blurriness" per se. I did not have double-vision, just a loss of visual acuity, which my neuro picked up on through some "quickie" eye chart tests. The eye probs disappeared within a few weeks, especially after I had stopped the Prednisone, antibiotic, etc. meds. I went for snother vision test with my optometrist and was found to be "perfectly the ame as before" -"no evidence of optic nerve involvement". However my neuro says that optic neuritis is a symptom of MS, and although his diagnosis has gone from peripheral neuropathy to possible acute transverse myelitis, he still lists MS as a secondary diagnosis. I have had absolutely no other episodes, my paralysis was totally symmetric, did not involve upper body, and bowel/bladder control, etc. have returned. I am now more than seven months post paralysis, walk OK, and my only remaining symptoms are mild dysesthesias (ie very mild leg muscle stiffness and burning sensations). I should mention that I am 59 years old - a little old for initial onset of MS, according to what I have researched.

I see my neuro again next month. What is known about optic neuritis and transverse myelitis? The transverse myelitis bb often mentions people complaining of vision problems, some quite severe. I had thought that ON was primarily a symptom of MS. My optometrist says that he doesn't think it was ON, just cranial nerve weakness brought on by the TM or whatever. Should I ask for another MRI? My last EMG and nerve conduction tests (2 months ago) were completely negative for peripheral neuropathy. I agree with your neuro MD's that this was a CNS and not peripheral nervous system situation. But MS is a CNS disorder and therein lies my concern. My eyes are fine, I have progressed very well, I have no parasthesias (except for that continuing numb spot in my lower back - and occasionally some lower back discomfort in same spot). I know MRI's are expensive, but I really want to know if I have spinal cord lesion(s), MS, or if this was just a one-time, post-viral, autoimmune "polyradiculoneuropathy" that I have a good chance to continue to recover from. Thanks again for your response. I am on HIP, and I wish your Clinic (which is not far from where I live) was on the HIP plan! I would love to get a second opinion there.

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Thanks for the question Jen. Transverse myelitis refers to inflammation of the spinal cord. It can present as you describe and can be seen as a precursor to MS. If patients have documented TM (ie the spine MRI reveals evidence of inflammation) and the story fits then a brain MRI should be done. If the brain MRI reveals evidence of demyelinating lesions then the 5 year risk of developing MS is around 70% depending on who you read. If the brain MRI is normal then the 5 year risk is down to 25%. Optic neuritis presents with essentially the same story as TM. Patients with ON usually have visual blurring problems and a scar is usually present on the optic nerve that can be seen by an optholmologist. A visual evoked potential study can also be helpful to determine if the optic nerve has been injured. Did you have a spinal tap doen looking for MS studies? If you did have an abnormality on your spinal cord then it seems reasonable to reimage the spine to make sure it is stable. It sounds like you have recovered well and I'm not sure anyone would initiate any treatment at this time even if it was determined that you did have MS. Good luck
This information is provided for general medical education purposes. PLease consult your doctor for diagnostic and treatment options.

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