Blurred Vision, West Nile Virus, Eye Stroke

[Sunny51]

A little over 2 mo. ago I started to experience soreness in my left eye. There was movement in the left corner of my eye There also was a reddish brown film covering the lower 1/8 of my eye. This continued to progress until a cloud covered my whole eye. Although it is less dense in the lower half than it was originally, the blurryness persists. I have been to a retinal specialist  (healthy retina/macula) and an neuro-opthamologist who put me on Cellebrex, an MRI, blood tests, and a lumbar puncture.  My MRI was normal except for "soft tissue thickening and enhancement anterior to the globes suggestive of periorbital edema. Both optic nerves appeared healthy." He thought that I most likely had had an "eye stroke"--"nonprogressive nonarteric anterior ischemic optic neuropathy involving the left eye." "Optic neuritis is a less likely diagnostic consideration." I tested positive for WNV (past episode).  (IgG He2.44/ IgM .06). The LP results showed 4 CSF O- Bands unique to the CSF. He did not think I had MS because the 2 clinical tests were negative for MS. He thought the bands might be from the WNV. The Myelin Basic Protein was .45 and the IgG Index was .44. About 3 weeks after the eye problem started I became extremely ill. I was diagnosed with sinusitis. I had no energy, a low fever--but was hot and cold. The cloud continued to advance until it covered my entire left eye and still does. I am still on Cellebrex, but toward the end of the day and when it wears off, I feel the swelling in my L eye and some in my R eye as well. They have not found any of the usual underlying causes for the eye stroke--high blood pressure, diabetes, auto-immune disease, etc. Could this all be related to WNV?  Should I still have inflammation after over 2 months? Is there anything else that can be done to relieve the inflammation, help with my vision? What tests, treatments, doctors, etc.? Could it be WNV encephalitis or meningitis? I was exposed to bat guano and had traveled to tropics.

[Michael J Kutryb, MD]

This is obviously a difficult case to unravel.  At this point there is no treatable cause identified yet.  The fact that you feel sick leads some credence to the encephalitis theory since you would usually fell normal after ischemic optic neuropathy.  I definitely am suspcious about the west nile virus being the culprit.  How many times would someone test positive for that - not often and you still don't feel well.  I really don't have any infomation to help you with your treatment at this point since I am not a neurologist but I would certainly talk with a very good neurologist and perhaps an infectious disease specialist.

[wooddragon]

A related discussion, Vision loss due to encephalitis was started.