Desperate for some help!

[kkrnkids]

Age: 43
Previous history of CSR (8 years ago)in right eye
No previous eye surgeries
Not taking medications

Around mid April I woke up and had decreased vision in my right eye.  Specifically it was like looking through a blurry gray or brown fog.  The discoloration continued to darken over the next week.  About a month later, the "greyness" decreased but vision is still blurred and darker if I'm out in bright light or get over-exerted.  About the time that the color issue improved, I started noticing pain behind the same eye.  The pain has increased - feels like a stabbing sensation - mostly when I move my eyes but is now to point where I feel dull pain always and sharp pain with movement. I've also noticed that colors are more muted in that eye (example bright yellow in left and pale in right and if I just look through right eye at car tail lights, I can't tell when they are lit up).  Eye is also painful to the touch.  

Its now been about 2 1/2 months since the initial onset. I've seen a retinal specialist (one that dx me with CSR) who said he didn't know what the cause was and referred me to Neuro-Opthamologist.  I can't get in with them for another month and a half.  Pain was so bad that I was in ER past weekend - had an MRI that was basically negative. Eye exam by opthamology was unremarkable except that vision field test clearly shows decreased vision in center of right eye and a small amt of possible scar tissue on my retina which could cause the blurriness. Said my optic nerve looks fine, but did mention that MRI showed something with my optic nerve sheath but it was "maybe, could be, ill-defined"...nothing noteworthy they said.  Opthamology suggested that maybe my headache was causing eye pain but I only seem to get a headache after eye pain.  

Any ideas on what could be causing the pain and blurriness if optic neuritis seems to be ruled out?  I'm in tremendous pain....

Thanks in advance for ANY input!

[Houman Vosoghi, MD]

Your symptoms sound a lot like optic neuritis!  How has it been ruled out?   You have to make sure the MRI included the orbits with FAT SUPPRESSION and MS protocol so they could evaluate the optic nerve better.  CSR could also explains some of your symptoms but the pain is what puzzles me.  Consider seeing a regular neurologist first if the neuro-ophthalmologist won't see you for so long.  Call them and tell them your symptoms and maybe they will move your appointment closer.

HV

[kkrnkids]

A quick update....after being treated by neurologist for ON (iv steroid followed by 12 day pred taper), the neuro-opthamologists office called and got me in this past tuesday.  The Dr there said it was Optic Neuropathy, not optic neuritis (indicated that was the case mostly because pain onset was after vision loss).  She upped my prednisone to 60mg daily for a month, followed by 10mg taper per month for next 5 months.

In meantime, my CSF results have come back:

http://www.medhelp.org/posts/Multiple-Sclerosis/Help-interpreting-CSF-results/show/1769612#post_8131824

So....if oligoclonal bands indicate possibility of MS....how does that fit in with the optic neuritis vs the optic neuropathy diagnosis?

[Houman Vosoghi, MD]

Thank goodness you got in with a neurologist.  I can't believe you were bounced around like that.  I'm glad our adivce may have actually made a difference.  Hopefully you will make a full recovery.

HV

[kkrnkids]

Just a quick update - saw Neurologist on Monday - she admitted me for 3 day course of Solu-Medrol w/oral taper after and gave me meds for the headaches. Feeling better!  She ordered MRI of spine - all clear.  Also did lumbar puncture - results still pending, won't know anything for a couple of weeks she says (they sent entire  speciman out accidentally instead of doing the " quick stuff" in house, so we will have to wait)  Just wanted to give a quick update and thank you again for your advice!

[Houman Vosoghi, MD]

So they likely did fat suppression based on that description.  MRI and your symptoms imply ON and the doctor said he didn't think it was?  That doesn't sound right to me.  Go see a neurologist right away.  Call your PCP for an urgent referral and bug some people to get in.  Visual recovery is quicker from optic neuritis if you get a dose of IV steroids for 3 days followed by 11 days by mouth.  Can't do too much harm either if there is a chance you do have optic neuritis.  Sooner better as it's already been delayed enough.  The evidence you have presented me with would lead me to conclude optic neuritis if I saw the same thing in my patients.  Be persistant in asking for answers.  Good luck.

HV

[kkrnkids]

as a footnote, the MRI technique says, "MRI of the brain was performed prior to and following the uneventful administration of Mutlihance 8 mL intravenous gadolinium contrast according to an orbital protocol.  This included high resolution axial and coronal sequences through the upper cranial nerves and orbits".  

[kkrnkids]

Looking at the MRI report, I don't know if it would even say anything about fat suppression or MS protocol, just says "MRI of brain and orbits without and with contrast".  Says , "slightly increased, ill-defined enhancement of the right optic nerve sheath complex within the orbits which may represent optic neuritis.  No evidence of demyelinating disease within the brain identified.  No orbital/intracranial mass lesions seen".  With that report and an exam in office they physician said they didn't feel it was ON.  Asked if I had headaches and I told them that with the extreme eye pain, yes I am getting headaches as a result.  They indicated that the headaches are causing the eye pain even though I feel its the other way around.  I had the eye pain well before the headaches and I only get the headache after my eye has "had it".   I feel like I got the brush off from the dr's I've seen (the original retinal specialist and now the opthamology dept at the hospital) even though the visual field test shows loss of vision, I'm obviously in extreme pain (I NEVER go to the ER - EVER and really don't complain about pain).  I called another neurology office today to see if I can get an earlier appt and am waiting for a call back.  If the MRI show just a trace amount of "enhancement" or no really cause could it be that I had ON and its resolving??  I'm just at a loss as to what else it could really be.