Double Vision - Optic Neuritis - MS?

[novakf]

Last November I woke up one morning with double vision. I actually could not see straight. I am Australian and at the time I was living in the UK. I had fairly recently arrived, wasn't registered with a doctor or anything like that. Anyway it terrified me when this happened, I got up and tried to see straight and eventually my eyes seemed to improve enough so I could go to work. But throughout the day my vision just felt weird. The next morning and the morning after that, again, I woke up with double vision which improved during the morning.

The following monday (5 days later) I went to the Doctor. The doctor did some eye tests, and sent me to an ophthalmologist. The eye doc couldn't find evidence of double vision (of course my appointment wasn't first thing in the morning!), my visual field test was fine, he dilated my pupils and didn't see anything there either. The double vision improved over the next two weeks until finally it went back to normal and I woke up feeling fine again. Anyway he was concerned enough by the acuteness of it and to check for nerve damage to send me to the eye hospital and also to get me a non-urgent MRI of the orbits and something else I don't remember. I had the MRI in January of this year, and was told in February that the MRI showed nothing abnormal and that what I had was probably just a kind of migraine. I found this hard to believe as I had no kind of headache except for eye strain during the whole time. Both doctors I saw didn't seem to think much of it and were really not too interested in getting to the bottom of it, so I just accepted it as some kind of random thing and forgot about it.

This August (a month ago) I arrived back home. Two days later I got a splitting headache which felt enough like a migraine for me to call it that. The headache was much worse when I moved my eyes. My right eye started to really hurt when I moved it, & I got really sensitive to light. I also had double vision when I looked up and to the right. I made an appointment with my doctor and went to see her on Friday. She referred me to another opthalmologist. I expected it to be a repeat of the last opthalmologist experience.

The weekend after I arrived back in Australia I had the headache and I felt very unwell and I noticed that my toes were slightly numb when I lay down at night, but it was quite a cold night.

The day before I went to the doctor I had noticed something over my right eye like a shimmery thing, like my vision was greyed out. This looks kind of similar to the migraine aura that I get sometimes, although that usually doesn't last more than an hour and would normally be before a headache. But this didn't go away. I noticed it more against bright backgrounds and when walking outside on sunny days (which is every day round these parts).

I went to the eye doctor and they tried to test my vision because I knew I also needed a new glasses prescription (I am quite shortsighted). Unfortunately they couldn't do it as it became obvious to everyone that the vision in my right eye was impaired and couldn't be corrected with lenses. The doctor then dilated my pupils, checked for double vision (which this time he found) and did a visual field test which showed my vision was reduced. My colour saturation was also reduced in the right eye.

The ophthalmologist diagnosed me with optic neuritis and booked me in for a semi-urgent MRI 2 days later. I had the MRI and it too came back clear apart from an arachnoid cyst in my left temporal fossa (I assume this showed up in the first MRI too but no one ever showed that to me!) There was also possible swelling and increased contrast in the right optic nerve.

In the meantime I continued to experience numbness in my toes at night.

The ophthalmologist referred me to a neurologist who booked me in for a handful of tests including ceretec (for stroke), visual auditory and somatosensory evoked potentials, chest x-ray, and blood tests for other random diseases.

Since my neurologist appointment I have noticed the numbness in my toes is getting worse. It is the middle three toes in my right foot and occasionally one of the middle three toes in my left foot. In the morning when I get out of bed the pads of my foot have been tingling and sometimes my whole foot will ache in the morning almost like a bad case of pins and needles. It's not something I've experienced before.

So, I have several questions:

1) Is the double vision I experienced last november likely to be related to the optic neuritis/other symptoms I have experienced?

2) Is the toe tingling and numbness something I should report to my neurologist BEFORE I see him again in late October for the test results and is this something that would significantly increase my chances of having MS considering that both of my brain/orbits MRIs have come through clear? Would the numb toe symptom definitely show up on my Evoked Potentials test if it is anything to do with the nervous symptom? Would this be something the neurologist would want to know ASAP? I am just not sure how seriously I need to take it. I guess I am worried but I don't want to seem impatient or silly by calling up the neurologist for no reason before he has the results of the tests.

3) Considering the MRIs are clear (although the first MRI was 2 months after the double vision appeared), what else could be causing the double vision last november and the optic neuritis and the numb toes? Is it possible these could all be random, unrelated events?

I understand you can't make a diagnosis without examining me, I would just like some idea of what the chances are of eventually being diagnosed with MS considering my situation, and also what information I need to give my doctors. And also if there are any other possible reasons for the co-incidence of these symptoms.

I happen to know the chest x-ray came back normal also.

[ski917]

Thought I would pass this along. My symptoms very similar,
According to medicos I have diabetes and diabetic neuropothy.
First session double vision turned to Occtomotor Palsy and four
month 95% recovery. Toe numbness now intermittent. Latest is
double vision bad in morning and getting better into the day. Blood sugar
has only been high once. It hovers at 99 and below. Good luck.

[novakf]

Thanks for the welcome message JemmAus - much appreciated! :D I'm in Sydney.

[JemmAus]

Hi novakf

Just wanted to say 'g'day' from one Aussie to another.....now I'm off to the Dr to report on my latest fun things.....hope you enjoy ( if you can enjoy such things?) the forum.

Cheers,

Jemm in brissie

[novakf]

Thanks so much for your response, slightlybroken. That's really helpful and I have read the health pages now. The diagnostic criteria make sense - I havent had any MRI of the spine - should I be asking for these or should I just wait and see?

[slightlybroken]

Hi and Welcome to the forum.

We aren't doctors on the forum but we can give you some insight, support, or information you might need for your problems. Here on this forum we are DX, or un DX (limboland), or we have close mimics to MS.

As to your questions:

1) It is possible that your double vision that you experienced last November is related to what is going on now. You can have ON (optical neuritis) further back on the optical nerve where it can't be seen through eye examination. So your probably thinking, why didn't it show up on MRI? If you haven't read the health pages, I urge you to do so. It will explain that some lesions will not be picked up on MRI. They are "silent" lesions. MRIs are good at detecting lesions but can miss small ones or if the machine is a low strength it can make a difference too.

2) I would tell your neuro of any changes in your symptoms. It's important that he knows what is going on, especially if it last more than 24 hours. Again please read the health pages about "How can a person with MS have a negative MRI?" Whether or not it will show up on evoke potentials is hard to say. It is a pretty sensitive test but sometimes it depends on the damage to the nerve as to whether or not it will show.

3) If you were to say that you just had double vision and ON, I would say that the double vision is related to ON. When you have ON it doesn't necessarily mean you have MS BUT ON is common in MS and can be one of the first symptoms.. But now that you are experiencing toe numbness along with the repeated eye problems, I would say that you really need to have this further investigated. By your symptoms, it is pointing to something neurological going on.

For you to be DX with MS, you have to show at least 2 episodes (where you had an attack and then returned to normal or almost normal/ it has to occur at least 30 days apart) and (most neuros require) evidence of 2 different places within the central nervous system that has been attacked. You have 1, which is the optical nerve. Now you have to have something show up in a brain MRI, c-spine or t-spine MRI, SSEP, BAER, or a positive LP for O banding for a DX.

Hope This Helps