Migraines, vision loss, uneven pupils--I'm at a total loss

[Lady_Iles]

I'm a 31 year old female. I'm pretty healthy except for having IBS for the last 10 years. I have never had any neurological problems or seizure disorders, etc, nor have I previously been a "migraine sufferer".

About a month ago, I developed the worst headache of my life. It was in the back of my head, right at the base. Along with the pain, I started having some very odd and scary symptoms--speech difficulty, loss of coordination/motor function, vision loss in my left eye, weakness/numb/tingling on the left side of my body, nausea and dizziness.  

I went to my doctor and he sent me straight to the Emergency Room.  The doctor there noticed another symptom--my tongue deviated to the right. They did a CAT scan and it was normal. My diagnosis that day was "Hemiplegic Migraine" and I was sent home with a shot of pain medicine and something for nausea.  A few days later, the odd symptoms went away, but it took a total of 13 days for the migraine pain to go away.  

I had a few days with no pain or symptoms, then I woke up one morning and wasn't able to see very well out of my left eye. It is almost as if someone was holding something in front of it and I'm trying to look through it. I saw my regular MD again, he did a CAT scan and it too, was clean. He said the vision disturbance was an "ocular migraine" and that my vision would return soon, that it's all part of migraines. My vision did return, temporarily, the next day.

For the last 2 weeks, I have had these "ocular migraines" (I call them 'half-blind' days) about every other day, sometimes lasting 2-3 days at a time.  I will wake up, and notice that I can barely see out of my left eye.  Or I'll be having a day where I can see "okay" (my left eye seems to stay blurry these days) and I'll be going about my daily life, and all of a sudden that black "shadow" is there again. The other day it happened while I was driving! (very scary)

My vision in that left eye has been getting worse and worse as time goes on. The last few times it has happened, my vision has been almost completely gone...it's almost like it's "blocked" by something, but it's not totally opaque. It's hard to describe--kind of like looking through a very dark glass.

My husband also noticed the other night while I was having one of my "half-blind days" that my left pupil was much bigger than the other.  I have also noticed that when I move my eyes to the left, and up, I get a shooting pain that goes from the eye into the head. It also hurts to press on my eyelid.

Could there be some opthamalogic cause for this?  I'm about to give up on trying to see out of my left eye altogether and just wear a patch over it so I at least have clear vision, even if it's just from one eye.  Do migraines really do this, and is it typical for them to occur so frequently?

[John C Hagan III, MD, FACS, FAAO]

Remember there is a vast difference in training and skill from an Eye MD to non MD optometrist.

However swelling of the optic nerve is serious. However papilledema means both nerves are swollen. If just one nerve it would be something else.

If you need a neuroophthalmologist I'm sure the Eye MD can get you in to one. They are a very rare set of skills and you may need to drive some distance to see one.

JCH MD

[Lady_Iles]

one more thing, he did say that my left pupil IS bigger than the right and less reactive than it should be.

[Lady_Iles]

Thank you for such a quick response.  I checked the site you mentioned, and there is not a neuro-opthamologist within 25 miles to me. (It would not let me search any further.I could not get an appointment with an opthamologist near me until late this month, so I settled for seeing an optometrist.  I saw him this afternoon; he dilated my eyes and after his exam said that he can see some swelling in the optic nerve of my left eye. (The one that is causing the trouble)  In his words, the swelling is "somewhat subtle" but it is there.

He has referred me to an opthamologist for Monday and mentioned that I would need one more MRI done, this one focusing more on the eyes.  I don't remember everything he said, but he said something about this having to do with spinal fluid and pressure...?  He did say that he was surprised my MRI of my head was clean, after what he can see in my eye.

I will see the opthamologist on Monday, hopefully I will know more then.

I did a couple of searches on papillodema .(I probably spelled it wrong) which is what he said this is... and what I read kind of scared me. Is this something serious? Can my vision be fixed or is it permanent? He didn't say much after talking about the swelling, seemed to want to let the other doctor do the explaining. :-\

Thank you for your help.

[John C Hagan III, MD, FACS, FAAO]

I would strongly recommend you see a neuroophthalmologist. Find one near you at www.aao.org or see a neurologist. You likely need further diagnostic work up plus treatment.

JCH MD