Any Ideas?

[zoltanvarga]

I posted before about a benign schwannoma (poss neuroma)I had tumour removed May this year.It was located c6 and had caused me over 2 years worth problems.Had an MRI for poss MS that,s when tumour discovered.Didn't have any significant probs in"head"BUT now I'm having problems focusing on close up stuff PC,books ect had a weird pain in left eye I could feel the shape of eye ball encompassed with the pain! Only lasted 5 mins had it twice this week still only lasted a short time. Also have a strange buzzing in my ears mostly in bed at night.Like someone has left a car engine running out side window, lasts till I go to sleep. Awaiting another MRI as neurosugoeon not happy as reflexes still too brisk,tingleing,vibrating back in hands ,legs and feet.Would it be possible to have this tumour AND MS given some sx came back after op and then went away( numbness came and went after 2weeks)Hope to get MRI soon but this is U.K and we are not known to get quick scans here, could have to wait up to 6 months!       Thanks in advance! Anne

[CCF-Neuro-M.D.-JT]

Optic neuritis (inflammatory eye condition that is in many cases a precursor to MS) is a possiblity as this is associated with eye pain and vision loss (especially light and color) for a few weeks at a time (not minutes at a time) and then usually spontaneously resolves. But could represent other eye problems too (glaucoma, cataracts, etc...), depending on your age and medical history.  Don't think the eye problems are related to the C6 tumor (keep in mind I do not know your full history and have not examined you or reviewed your films), but if it does turn out to be optic neuritis, then you could be at risk for developing MS. Instead of waiting for an MRI, see an eye doctor about your vision problems. Depending on what they see, you may need treatment that is best given early in the course of the illness. As for the MRI, you may want to ask your surgeons to get an MRI of the brain along with the spine also if MS is really suspected. Good luck.

[Annika]

Dear Zoltanvarga,

There is a very good online support group for patients with tumors inside the spinal canal.  Although the name of the group is "Spinal Cord Tumor Support," about half of us had spinal tumors that were not within the cord itself, but just outside the cord, inside the spinal canal (intradural, extramedullary tumors - which it sounds like your schwannoma was).  This site is very well established, an extremely respectful community of patients with problems similar to yours.  Most of us have had the tumor removed long ago, and many of the problems we discuss and share information about have to do with long-term complications after surgery.

Here's the website (if it's okay to include this here - I hope so):

http://www.aimoo.com/forum/categories.cfm?id=320177&CategoryID=12294

You're actually not the first cervical tumor patient, by far, to develop eye problems.  The eyes are controlled not only by the optic nerve itself, but also by cranial nerves 3,4 and 6, which control the focusing and movement of the eyeball.  Several other cervical tumor patients have developed problems in areas controlled by the cranial nerves and/or their control centers in the brainstem (these include problems with pain/sensation in the face, ringing in the ears, feeling of pressure behind the ears, dizziness, lots, lots more - different combinations for each person).

For some reason, as the eyes go, a favorite nerve to be hit in these cases seems to be cranial nerve 3 - causing an imbalance in the muscles around the eyes that makes it difficult to focus at close distances.  These patients are often found to have an "exophoria," which simply means that the eyes seem to want to look out in slightly different directions.  An ophtalmologist can do a test to look for this, but usually it's not immediately apparent by looking at the patient.  The patient will, however, complain of eye strain, blurred vision at close-medium distances, and having trouble holding a focus (the eyes seem to want to glide out of focus if you don't work hard).  Many of the patients who develop this problem have it come up fairly suddenly, and are too young to be going through the usual age-related eye-changes that one might otherwise think of.

Here are a few of the possibilities that usually have been evaluated with those patients:

1.  Tumor recurrence (higher up)
2.  Scar tissue formation at the site of the surgery that limits the normal upward movement of the spinal cord, and causes traction at the site where the spinal cord leaves the skull.  This is the biggie.  Do the visual problems seem to get worse when you look down, tuck your head forward, or sit for long periods?  Some of these positions can happen when you're driving, reading, typing at the computer, or even eating (because you look down at your plate).  This problem is hard to see on MRI and generally has to be diagnosed clinically (meaning, by your symptoms).  There will, of course, be scarring in the post-surgical area, so it can be hard to interpret whether it's limiting the movement of the cord or not.
3.  Impaired CSF flow within the cord/brainstem - again, this is usually linked to scar tissue anchoring the cord.  
4.  Spinal stenosis from post-surgical changes in the muskuloskeletal spine - although usually these people have symptoms in the neck/arms.
5.  A variety of other spinal abnormalities that I don't want to scare you with, like a syrinx/syringobulbia (the extreme endpoint of CSF backup within the spinal cord).  Usually people with those problems have much worse symptoms.  But it is a possible complication of post-surgical scarring, and so often people will look just to rule it out.

MS does, of course, come up as something that has to be ruled out in all the patients who have described these problems.  But you should know that, whatever the actual cause is, there's a pattern to this that comes up with some frequency among patients who have had cervical tumors removed.  So I don't mean to say what I think might be going on with you, but simply to give you some sense that it's a familiar story once you talk to enough spinal tumor patients, and these are some of the issues that usually get evaluated.

If you do visit the support group, I hope to see you there!

Good luck,
Annika

[zoltanvarga]

Thankyou so much for your help, you seem to have a REAL understanding in what's going on with me! I was seriously begining to question my sanity:) I will visit the site you recommended and see if I can try and make sense of what is going on! It really is reassuring when someone like you can relate to my problems. Thanks again for taking time to write! Are you medicaly trained? As you talk lot's of sense. Thanks again  Anne.