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Neurology (Expert Forum)
Any ideas?
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Any ideas?
by RobbyK, Mar 19, 2002 12:00AM
Quick hx: DEC99 - dx as Optic Neuritis in right eye. MAR99-Steroids(oral) for progression of Visual Field loss(VFL). JUL99-ON dx vacated for dx NA AION. 85% VFL in Left eye in 3 week period, slight progression in rt (patient anemic). 3 month steroid course (IV then oral)with some recovery. Slow progression of VFL left eye through next 8 months followed by 3 week steroid course(IV/oral). Weakness, fatiguability, fasciculations noted(passed off to anemia/steroid side effect). Empirical 6 mo. course of Avonex started FEB01. Anemia and leukoerythroblastic cells cleared by NOV00, dx now bilateral Optic atrophy(pale disks, no cupping, IOP normal). Positional and resting tremors noted APR01(rt. arm first). Neuropsych testing in JUN01 noted cognitive problems NOS(near subcortical dementia). Suprination of rt foot in AUG01. VFL stabilized SEP01. Suprination of lt. foot DEC01. Cognitive progression
minimal JAN02. 4 MRI all clear, 5 LP (all with marginal high or normal opening pressure, CT enlarged fatty liver and one diminutive kidney, LHON screen normal, and all blood work in normal limits. Faciculations, tremors, weakening, fatiguability all continued but diminished/slowed progression after removal from Avonex. Nocturnal O2 desaturation(down to 73% during REM) found(same before and after UPPP and tonsilectomy)(MAR02). Range of motion in most joints restricted. Headache, joint / muscle pain, and eye pain daily. Failed VEP, NCS normal(No EMG done JAN00). Have investigated on internet, and would appreciate any ideas). Previous post in OCT01(unknown etiolology).
minimal JAN02. 4 MRI all clear, 5 LP (all with marginal high or normal opening pressure, CT enlarged fatty liver and one diminutive kidney, LHON screen normal, and all blood work in normal limits. Faciculations, tremors, weakening, fatiguability all continued but diminished/slowed progression after removal from Avonex. Nocturnal O2 desaturation(down to 73% during REM) found(same before and after UPPP and tonsilectomy)(MAR02). Range of motion in most joints restricted. Headache, joint / muscle pain, and eye pain daily. Failed VEP, NCS normal(No EMG done JAN00). Have investigated on internet, and would appreciate any ideas). Previous post in OCT01(unknown etiolology).
Doctor's Answer
by CCF-Neuro-M.D.-JT, Mar 22, 2002 12:00AM
Sorry to hear about your symptoms. I reviewed our previous communication in 10/01. With your numerous MRI's and LPs all coming out to be normal, the diagnosis of MS becomes less and less likely. As I have not perosnally examined you nor have I reviewed our films, I cannot give you an accurate diagnosis. However, one thing that can cause many of your systemic problems such as headache, wekaness, and joint symptoms as well as optic atrophy would be sarcoids, an inflammatory/autoimmune disease that can be evaluated with testing such as chest Xray, blood test for ACE, and biopsy. Just a thought.
The eye pain and vision loss appear to be a major problem and should be thoroughly evaluated before any progression of symptoms occur. As I recommended before, consider a second opinion by a neuro-ophthalmologist at a major academic center close to you as a definitive diagnosis has yet to be made. Good luck.
The eye pain and vision loss appear to be a major problem and should be thoroughly evaluated before any progression of symptoms occur. As I recommended before, consider a second opinion by a neuro-ophthalmologist at a major academic center close to you as a definitive diagnosis has yet to be made. Good luck.
