ms

i have an unofficial dx of ms as my brain and csp and tsp are full of plaques and i had one episode of weakness 1 yr ago. however i did not allow the spinal tap for the dx as i am a health professional and do not want the dx in my history, i am a vegan, very healthy in my 50 s and  feel my health has staved off consistent symptoms.  however, i am no expieriencing flashing lites in the periphery of my left eye ,,i m hoping it s a vitreous changes but can it also be ocular neuritis related to ms?  thanks for your help.

[Shazia Alam, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

Given your history of “MS,” I would be concerned of a condition called Optic Neuritis.  Optic neuritis is an inflammation of the optic nerve, the bundle of fibers in your eye that transmits information to your brain. Symptoms include pain in the eye and vision loss, but can also be associated with flashing lights. Color vision loss can also occur. Optic neuritis may be viral, may have no known cause, or may be a manifestation of multiple sclerosis. Most people who have one episode will recover their vision. While eye exam may be entirely normal, another test, called the visual evoked potential, which gives information as to how long electricity takes to move along the nerve, will be abnormal and will point to the diagnosis. Other causes of optic neuropathy, or problems with the optic nerve, that are not demyelinating, can also occur.

There are multiple other causes of transient visual obscuration, one of which is transient ischemic attack, or TIA, whereby a small artery to the retina gets clogged with clot. This is a sign of increased risk of stroke. This is more likely in people older than 50 with diabetes, high cholesterol, high blood pressure, or other factors that increase risk of stroke. In patients older than the age of 55, a type of inflammation of one artery in the head called the temporal artery, a condition called temporal arteritis needs to be ruled out.

Ocular migraine (also known as opthalmic migraine or ocular migraine) is thought to be a variant of migraine in which headache may not occur, but there is often a family history of migraine disorder. It is a difficult diagnosis to make as there is no specific test for it, but if other causes of vision loss are excluded, the diagnosis may be invoked. It is more commen in women, and symptoms may include transient vision loss, flashes of light in the peripheral visual field, or other similar symptoms lasting usually 30 minutes or less. Headache may or may not begin within 60 minutes and is often one-sided, throbbing, and may be associated with nausea and light-sensitivty. Ocular migraine is not necessarily triggered by entering a dark room, but different people have different migraine/migraine-variant triggers.

I would HIGHLY recommend being checked out by a neurologist and an ophthalmologist in case you need to start a course of IV steroids to prevent progression of your vision changes or relapses.  

Hope this information was helpful.