Sunday, February 20, 2011 Paula asks

Q: Optic nerve inflammation-left eye more than the right, headaches, nausea, dizziness, tinnitus in left ear with morning and evening whooshing noise, and occasional numbness in left arm and leg...ideas?

I went to an optometrist because I was getting some blurred vision and floaters along with daily headaches (from the moment I awoke) that seemed to occur right through my eyes like someone was taking a knife, jabbing it in and twisting it, and frequent dizziness. The dizziness would come on in a wave like the room was spinning (or the road was...)and I would have to sit down immediately. It always caused me to become sick to my stomach and sometimes vomit. I have been to a neurologist and a neuro-opthamologist. The optometrist thought I had retro bulbar optic neurosis, but the neuroopthamologist was sure that I had pseudo tumor. A lumbar puncture to test the pressures only (why they didn't test the fluid is beyond me... I even asked when having the puncture done and was told that the pressures was the only thing ordered) was conducted and the pressure was very low instead of high. The neuroopthamologist did not conduct any other tests and said that he couldn't help me. I have been to three neurologists; the third I really liked but he moved away and now I have to start with a new one on March 3. I have had a brain MRI and some blood tests to check the hemoglobin, white and red blood cells, etc. Everything came back normal or within range. Lately my headaches aren't quite as severe... I have Imitrex, naproxen, and take effexor daily. I have tried to limit the Imitrex and naproxen to only the times when I can't take it any longer and am not able to lay down in the dark with a cold cloth over my eyes. I have noticed however that I am always feeling fatigued, have more numbness followed by a tingling sensation on my left side appendages, and my left eye has been twitching more and more. I am also getting what I am going to call "star light" occuring three or four times a week now... like little stars dancing in my sight for up to half a minute and then they are gone. I have researched and researched online about retro-bulbar, pseudo-tumor, and even MS. I have spoken with people that have had pseudo-tumor and others with MS. More and more people are saying that they think I have MS. One friend who has the primary progressive MS has a sister with the Relapse remitting MS. We have spoken often and he really thinks I have the same thing as his sister. He suggested that I ask for another lumbar puncture to test the spinal fluid and a spinal MRI because he and his sister had no lesions show up on the brain MRI but had several show up on the spinal one. He also suggested that I start taking additional vitamins to help with the fatigue, etc. I started taking additional vitamin D (2,000 IU) and additional B complex (with vitamin C right before to open up the cells in order to absorb the B) with my normal multi-vitamin about a month ago. It does not seem to be helping with the fatigue though, I am still always tired. Do you have any suggestions? Could this be the relapse-remission MS? Should I ask the new neurologist to perform any other tests to rule out the possibility? I guess I just want to be prepared when I see this one because it has been going on for a year and four months and nothing has been diagnosed yet. I am just being treated for migraines.

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Answers (1)

Eye inflammation

8/18/11 9:37pm

I have no medical training, but I work for a neurosurgeon. They can order an LP without testing the fluid to determine the pressure of the CSF moving through the canal. High pressure with the headaches, dizzyness, etc can indicate that you have too much CSF (cerebro-spinal fluid) around your brain. Your body creates this naturally as a way to both cushion and nurish the brain. When it doesn't drain properly through the spinal column to be reabsorbed, it can cause pressure on the brain eventually leading to hemorrhages and death if left untreated. Testing the fluid is an entirely different diagnosis set looking for things like high protein levels or cancer cells. It's too bad that the doctor didn't take the time to explain the difference to you.

You can have lesions in the brain, spine, or both. The best way to evaluate that would be an MRI of the entire neuro-axis (brain and all 3 parts of the spine) to look for nodules, lesions, or tumors. A pseudotumor presents all of the symptoms of a cancerous (benign or malignant) tumor, but without an actual tumor present. Sometimes there is a cyst, but more often there is nothing there. There are a few different medications that help with this condition, some people end up getting a ventriculoperitoneal shunt, but most are managed by a neurologist to control the pain and other symptoms you described. If you haven't already, ask your neurologist or family doctor to refer you to a neurosurgeon for a full evaluation. For the best results, ask that they be board-certified by the AANS and CNS which means they have had both extra training and are required to keep up on the latest advancements through online classes and conferences.

The other suggestion would be to see a vitreoretinologist which is another type of ophthalmologist to see if there is inflammation in the other parts of the eye besides the optic nerve. I have many of the same symptoms: headaches, nausea, sparkles, tinnitus, etc. I have an inflammatory eye condition that is treated with steroids and anti-cancer drugs. You could have something similar or what are called ocular migraines which also have similar symptoms. These are more rare and less likely to be identified by your normal eye exam. You would need an OCT (occular coherence tomography) and an occular flueroscein angiogram.

Q: Optic nerve inflammation-left eye more than the right, headaches, nausea, dizziness, tinnitus in left ear with morning and evening whooshing noise, and occasional numbness in left arm and leg...ideas?

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