need to know diagnostic possibilities

[quenepa]

54 year old female with 6 weeks of the following history:

started with pressure like in medial aspect of superior eyelid area with sensation of limited upward gaze. but gaze was ok
developed over the week in pain in the opthalmic region of the trigeminus, swelling of eyelid, mild redness, tearing and initially mild visual loss - like a glass with mist water.

pain continued and all symptoms other symptoms continued. NO fever , no other symptom

visual loss increased to develop scotoma with loss of partial visual field

seen by optha and found edema of rt optic nerve with hemorrghes witn retina fine. no third nerve involvement.

all labs and neurimagin studies are negative for tumor, MS, neuritis, fistulas, vascular lesions, etc

blood labs negative for bartonella, lymes, sarcoidosis, ana, ra, sed rate = 10, cmp, cbc, etc

started wit 3 days of solumedrol iv pulse follow by prednisone 60 mg - 50 and now 40 mg.

scotomoa improved and edema and hemorrghes improve but my question is

opthalmic trigeminal nerve pain has continued in a way that comes and goes, sometime has the impresion is improving other times worsening. tearing has continued and pressure like in the eyeball and fromtal area persist.

continue under medical evaluation but would like diagnostic possibilities that relate all this symptoms with the opthalmic pain neuralgia. also I can see my own pulse in the eye field. (in spite aneurysm and vascular lesions have been rule out.

Could you help in diagnostci possibilities and possible scientific explation for all this symptoms combined?

thanks

quenepa

[Michael J Kutryb, MD]

I am much more concerned about the vision loss and optic nerve edema.  You could have possible had optic neuritis.  This then raises the possibility of multiple sclerosis as a possible cause but fortunately the MRI of brain was normal.  You should see a neuro-ophthalmologist for evaluation.

MJK MD

[quenepa]

Thanks. Yes I am under the care of a neuroopthalmologist, general ophtalmologist, retinologist, neurologist, internal medicine and others. Thanks for your response again. It has validated information and in certain way relief.  I will take much care


quenepa