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Optic Neuritis/Papilledema
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Optic Neuritis/Papilledema

One month ago I had a fever of unknown origin that lasted for two weeks.  I was treated with Levaquin.  My only other symptom was severe headache. On the 8th day I awoke with a black spot in the vision of my left eye.  After seeing an opthalmologist I was told that I had optic neuritis.  As I also have colon cancer a brain MRI was also performed.  Here is the impression:  There are several punctate foci of T2 hyperintensity primarily within the brainstem but also within the deep white matter of the corona radiata and centrum semiovale.  The patient's history of a recent left opthalmic arteriogram with "vascular inflammatory changes" is noted. Is this significant?  I'm supposed to follow up in a month but there has been no improvement in my vision and I hate "the wait and see" approach.  My oncologist feels I should see a neurologist and also feels that I should be on a steroid regimen but I can't get a referral without my PCP's agreement and he doesn't feel that referral is necessary at this time. Any thoughts/suggestions?  Thanks!!
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Extremely hard to accurately comment on an MRI that I have not personally seen. And your personal history (including age, sex, stroke risk factors such as stroke, diabetes, heart disease, cholesterol) is also very important to know in making a clinical diagnosis. What I can tell you is that optic neuritis is highly associated with a neurological disease called multiple sclerosis which is an immune mediated process that affects the myelin or nerve coverings in the brain. This can show up as several white spots on an MRI. There are characteristic places where they tend to be in the brain which helps us with the diagnosis.  Also, tHere are other optic neuropathies that are related to lack of blood supply or vascular inflammation that can be associated with little strokes in the brain.  Again, I cannot make a diagnostic call without personally reviewing your clinical history, examining you, and looking at your films.  But I agree with your oncologist: you definitely should see a neurologist to help you sort this out so that you can get the appropriate treatment. Further evaluation may also be needed. If you are having trouble convincing your PCP to act on this, consider having your oncologist talk to him or write him a letter. This is not something that I would consider a "wait and see" kind of situation.  There is a real medical problem that has been defined by your ophthalomologist and an abnormal MRI which should be taken into consideration with your eye findings. Try to get the referral. Good luck.
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Thank you for the help and support.....I am a 36 year old female with 4 year history of colon cancer w/mets to liver, lung, left kidney, chronic hypertension.  I have had recurrent DVT's and a pulmonary embolism.  Cholesterol is fine.  We have filed a review with the HMO and are waiting the 30 days to see if they reconsider.  We sent a letter from my oncologist along with our plea.
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