Migraine/lights in eyes/Lupus??

    
      Re: Migraine/lights in eyes/Lupus??
    


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Posted by ccf neuro M.D.* on November 08, 1997 at 22:39:56:

In Reply to: Migraine/lights in eyes/Lupus?? posted by Bonnie Kirkpatrick on October 24, 1997 at 13:34:45:
  Hi,
  Me again... in reading a post by Michelle Himm(10/07/97)and follow-ups, I am wondering...At or near the same time my tailbone pain started, I had problems with *flashing lights* in my eyes..episodes lasted abt 20-03 min ea time..no headache to speak of... then my shoulder froze... X-rays said I had arthritis in my neck..rheumatologist figured that was the ultimate cause for the frozen shoulder..he ordered blood work also which showed a positive ANA(1:160) and slightly elevated ESR(22)  The Dr stated that altho my ANA was positive, I had no symptoms of lupus clinically.  The *lights in the eyes*  episodes I saw an eye dr for, & he sent me back to my family dr, who put me on Coumadin therapy..I am at 6mg/day plus one aspirin...I have had no lights since, except when I had a bleed in my eyelid, and they stopped the coumadin for a week or so...they put me back on, and no more lights... I guess I am now wondering if in fact this could all be connected somehow... Sorry for the length again, but I couldn't figure out any shorter way of covering it.
  Any help or insight would be appreciated... I am getting tired of Drs...:^))
  Thank you in advance...
  BK
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Hello Bonnie!
Episodes of flashing lights in your eyes for 20-30 minutes duration are virtually diagnostic for a condition known as migranous auras. Many people with migraine headaches have these auras prior to getting their headache; however, there are people who have the headaches without the auras, and people who have the auras without ever getting a headache. In order for such a diagnosis to be made, however, a CT scan or MRI scan of the brain should be performed to exclude the unlikely possibility of a brain tumor, vascular malformation, or stroke. A family history of migraine headaches or similar spells is very helpful in confirming this diagnosis--- do any of your sisters or mother have migraines or bad headaches?
Coumadin is a blood thinner used to prevent strokes and blood clots. If you have not seen a neurologist about these symptoms, I would STRONGLY suggest you do so, and preferably a neurologist who specializes in the treatment of stroke specifically, since the question in your case would be whether these spells are TIAs (ministrokes) or the migranous auras I mentioned, which are far more likely in anyone young in particular. The distinction is extremely important because the treatment for the two is very different, and there are serious risks of bleeding associated with the long term use of blood thinning medications like coumadin--- it sounds like you've already had a bleeding episode. If Cleveland is reasonably close to you and you wish to see a member of our neurology staff, I would suggest Dr. Tony Furlan or Dr. Cathy Sila in particular, both of whom are experts in treating stroke and related disorders, and could sort such an issue out. The number is 1-800-223-2273 extension 45559 (neurology appointments).
Positive lab tests in the absence of appropriate corresponding clinical symptoms are meaningless with some rare exceptions. Unless you develop more compelling signs of lupus I would not worry about an isolated positive ANA. There is a condition called lupus vasculitis where the blood vessels of the brain are inflammed and this causes confusion, disorientation, and eventually brain damage from multiple small strokes in the brain. People who have this problem are usually VERY VERY sick, however, and it is obvious that something really bad is wrong, so it is not a serious consideration in your case based on the symptoms you describe. Again, I would strongly suggest another (neurologist) opinion on these spells.