optic nerve damage-Permanent?

[2jranch]

I am a 52 yr old female, noticed in December of 2002 a cloudy spot in vision of left eye only, upper right quadrant.  Optometrist did a visual field test, during which the machine would not focus on the left eye; and told there was a problem in the occipital lobe. Told me a brain tumor, anreuysm or clot, so ordered a catscan.  Cat scan was normal, sent to a neurologist.  Neurologist did strength and other tests. Height 5'7, weight 155#, fasting cholestorol was 166, hdl59, LDL 99, Tryglycerides 42, glucose 101.  Tests for inflammations, clotting and flow rates were perfectly normal.  I have had no other complaints or illnesses with this.  No headaches, no numbness, dizzyness.  The only time I have seen a doc was for shingles on my right hip in 1992.  The neurologist said to continue taking my aspirin a day as I have for 30 some years, and call if I have any other problems.  He stated he felt I was too old for MS, and I didn't have any other conditions that would point in that direction.  He said (in February) that he felt the vision would return to normal within 3 months.  Stated I should follow up with my general practitioner as there was no neurological problem.  The problem is my general thinks I should go to another neuro guy, as he feels it has to be ms.  I asked about the possiblility of shingles, the general said I can't get it twice.  By the way, the neuro didn't do an MRI, as he stated it wouldn't change the way he treated me, and the cat scan and the blood tests were enough to rule out a neurological problem.  Where do I go from here? Do I wait and see?

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

I agree with your GP regarding a second opinion.  Further workup should be done including an MRI of the brain (CT is not enough). Visual loss is not something to be taken lightly.  FIrst of all, it's very important to distinguish if this is an eye problem or brain problem.  A formal ophthalomologic exam (not just optometrist - see an M.D.) with visual field testing should be considered.  A simple test you can do at home is to close each eye one at a time and see if you're still missing that upper right quadrant even with the right eye.  If so, then it's likely a brain problem. Stroke or MS are major possibilities with the treatment plans greatly differing from one another, which is why I would tend to be more aggressive in figuring out exactly what this is so you can get the right treatment.  And even if it was a stroke and no apparent clotting problems were present, aspirin is obviously no longer cutting it for you for stroke prevention.  More aggressive meds may be needed like plavix and blood vessels should be looked at in the brain and neck.

Until we know exactly what the problem is, it's impossible to give a prognosis.  What I can say is that if it's a stroke (in the occipital lobe as your optometrist mentioned) then the vision loss will likely be permanent, whereas if it's optic neuritis associated with MS, there may be return of the vision.  Get a second opinion. Good luck.

[2jranch]

I should add, there is no history of ms in family. I have had migraines over the past 30 some years, average of 3 a year, some years none.  It is always proceeded by the flashing zigzag lines, which quit when the headache starts.  Aspirin generally takes care of the problem.  I have not had a migraine in about 2 years prior to this problem.  The blurred spot in the left eye is hardly noticable in the bright daylight, except that when using only the left eye, that portion makes white look a little yellow, but blues look blue, red looks red. In very dim light it just looks dark and cloudy, but if I focus up, I can see true colors in the bottom of my vision.