Complex migraines or early MS

[te6698]

I'm a 29 year-old female who began having loss of peripheral vision back in July. I had 3-4 20 minute episodes of losing peripheral vision in one eye at a time (was like blackness came from the side of my vision) within a 2 week period.Symptoms then changed a bit to what neuro says are ocular migraines - reading about ocular migraines they do seem to fit except they can occur in both eyes at the same time, not just one which seems to be the typical symptom.Normal MRI of brain and C-spine and an MRA of head/neck which questioned stenosis in left internal and external carotid arteries.Follow up carotid ultrasound was negative.Bloodwork showed elevated CRP level, other blood tests neg for lyme,RA,lupus.Hx of early heart disease in family.Personal hx of high cholesterol, triglycerides and recently high BP.Neuro put me on Verapamil to see if it helped the ocular "episodes" as well as to see if it helps my regular migraine headaches.Episodes occurred again for roughly 4 weeks from August -September and other syptoms (symptoms) started occuring independent of the migraines or ocular migraines such as feeling of heaviness and/or weakness and tightness in arms.All symptoms resolved in late September until mid January. Now I am again having ocular disturbances nearly daily,arm aches/weakness and now occasional leg weakness for past 3 weeks - do these sound like MS symptoms?What about the normal MRI? Also worried about possible carotid issue given abnormal MRA, but normal ultrasound?

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

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.  
    The symptoms and story that you relate are not specific for any single disorder, but are most consistent with migraine headaches.  Migraine headaches often have an 'Aura' which can preceed the headache, but can also occur during or even after the headache.  The most common auras are visual, including sparkling lights, fortification spectra, a loss of peripheral vision and seeing halos around objects.  Less common auras include numbness/tingling over part of the body, weakness on one side of the body (also called hemi-plegic migraine), confusion spells and problems speaking (also called aphasic migraines).  The problem is that there is no test to confirm a spell is a migraine, except that it will get completely better with no residual problem in a few hours or so.  Much of the testing in cases of suspected migraine related symptoms surrounds ruling out other diseases and trials of empiric medications.  An MRI of the brain and cervical spine is a common first test to evaluate for things like Strokes, tumors and multiple sclerosis (all of which can cause similar symptoms).  When the MRI is normal, this makes migraine much more likely (but does not prove it).  A trial of a medication used to prevent migraines can provide more evidence for migraine if the spells improve/respond to the treatment (but again this is also indirect).  Some medications work better for certain people.  If verapamil, did not seem to work that well, you should try some other medications such as Nadolol, Topamax, Elavil, etc. until you find the best medication for you.  I would also encourage you to have a repeat MRI whenever you have a change in your symptoms, such as when you developed the weakness, to evaluate for any other possible causes for the symptoms.
   The MRA (magnetic resonance angiogram) is a calculated flow study (based on the time of flight +/- GAD contrast) that can often over estimated  a possible vessel stenosis.  Inaddition, many artifacts from metal/baces/etc in the mouth and interfere with the signal at the level of the carotids.  Getting an ultra sound is a good first step to determine if real pathology is present.  If doubt continues, a CT angiogram is a better study to determine a more accurate lumen of the carotid vessels.
   I do not think your symptoms are consistent with multiple sclerosis(MS).  MS usually presents with focal neurologic deficits that last for several weeks at time and then get mostly better, but the deficits build up over time.  Common MS symptoms include pain in one eye with blurry vision (also called optic neuritis), double vision, numbness and tingling, and focal weakness.  The MRI generally has more lesions that the patient remembers having symptoms for , since only lesions in select areas cause symptoms.  If concerns about MS persist, then I would suggest a lumbar puncture (to look for inflammation, IgG index, oligoclonal bands) and visual evoked potentials (to look for evidence of past optic neuritis).
  Finally, I am concerned about your history of high blood pressure, high cholesterol and elevated CRP (these all increase your stroke risk).  I would suggest that you contact your primary care physician about anti-hypertensive medication and a possible statin (for cholesterol).  
I hope this has been helpful.

[robertmillerfoundation.org]

Hi, I'm sorry to hear about your mystery symptoms.  From my understanding this does not really sound like MS since visual symptoms with MS occur is only one eye most of the time (someone correct me if I'm wrong about that).   With a normal Brain MRI, this makes MS even less likely.   This is just an idea, but have you been evaluated for pseudotumor cerebri?  Do you ever hear your heardbeat in your head/ears?   It might not hurt to see an Neuro-opthamologist for an eye exam.  I hope you feel better soon

[JCmcc]

actually you are incorrect about that.

[te6698]

I have seen a neuro-opthamologist at MA Eye & Ear Infirmary in Boston back in June. They did give me a thorough eye exam including testing my peripheral vision - everything was normal. I should mention that when this all initially started back in June, it was strictly vision issues. First it was blackened peripheral vision (one eye at a time) and it then changed a bit to blind spots in my vision,one or both eyes, then the feeling of looking up from water or looking through a heat wave. The initial episodes in June lasted 2 weeks then completely resolved. Everything started up again in late August-late September, that is when the heaviness/weakness in my arms developed also. Afer that everything was fine until mid January when it all started again, now I am also experiencing problems with weakness in my left leg. The arm/leg issues don't occur at the same time as the vision episodes. The vision episodes occur on and off for 10-14 days, sometimes a few times a day, some mornings I open my eyes and I am immediately having an episode. Once the vision episodes start to resolve is when the arm/leg problems seem to start and those last a few weeks themselves. It's all really frustrating.

[triantafillos]

hi,
Its very frustrating, I agree.  I'm sort of in the same boat, and to me, most of the symptoms you're describing sound migraine related.  I have been battling with them for about 17 years, and they are just as mysterious to me now, as they were then.  I think it’s the wide variety of symptoms that always keeps us guessing.  I too first had an aura that included jagged lights, followed by blind spots, etc.  I would usually experience a numb area on the back of my hand that would slowly progress up my arm, to my neck, and then leave the side of my face and lips numb.  The numbness also brought with it a feeling of weakness, but I'm not positive it is what you're describing.  When this ended, I knew I had about 20 minutes until the throbbing would start.  I would usually have vomiting, diarrhea, and runny nose (like my body thought it was being poisoned, or had a bad case of the flu).
About 5 years ago, after recovering from one particularly nasty headache, I began seeing a flickering in both eyes.  It was a stumper.  Went to an ophthalmologist, he said everything was normal… told me to see a neurologist.  The neurologist couldn’t find anything wrong either.  I still have the flickering, 24 hours a day, whether I’m experiencing an actual “migraine” or not.

As the Doc said, many affects from the aura can last for weeks. Here's a link to a study showing your visual field can be affected for up to 75 days...

http://www.iovs.org/cgi/content/abstract/41/5/1239

I would say that the symptoms affecting your vision are definitely migraine related (I am just getting over a migraine from yesterday, and am experiencing the "heat wave" type effect you've mentioned).  I don't know about the "heaviness" in the extremities you've described, but the fact that these symptoms begin when the visual ones stop, kind of makes you think there has to be a connection.

[sam85204]

I am a 31 year old male. My first episode of a migrane like headache with aura occured in August of 2005. As of Jan 2007 I started experiencing some unusual symptoms two days after eating a very, very large meal:

Chest pain (boreing type)behind left pectoral
Fainting feeling
Abdominal pain (near gall bladder)
Back pain (stabbing)
Heaviness in chest
Numbness and tingling in arms and legs
Strong headache (including ears and eyes at times)
Cold extremities
No appetite
Weight loss (20 lbs Jan 6 to Feb 25)
Grossly dilated pupils (sometimes unevenly)

These symptoms persist today.

All taken blood test are normal except for slightly high bilirubin (possibly from fasting. I haven't had cholesterol checked yet but the last time I did it was high. I am currently waiting for test results for Valley Fever, Thyroid and Ulcers. I've had a full abdominal ultrasound and CT head and CT from neck to groin with and without Iodine, all were normal. EKG was normal.

Any ideas?

Sam