Monday, June 30, 2008
I have had recurrent attacks of optic neuritis with Uhthoff's for the past five or six years. (I am 54, female.) This year, I began to experience nystagmus, blurring and double vision. Although my optic nerve is pale, my MRI is normal. I've seen a cardiologist, ophthalmologist and neurologist. Diagnostically, we're at an impasse. What could be causing this triad of symptoms other than multiple sclerosis?
Uhthoff's symptom is when patients with optic neuritis notice that their vision gets worse with increased body temperature from exercise, hot water, hot weather or other factors. Optic neuritis can occur as an early symptom of multiple sclerosis, but it can also occur as an isolated incident unrelated to multiple sclerosis. With this condition, the optic nerve connecting the eyes and brain becomes inflamed and the protective myelin sheath around the nerve can be damaged, similar to the myelin damage seen with MS.
Studies have shown that if someone has optic neuritis with a normal MRI, the risk of going on to develop multiple sclerosis is fairly low. Although you feel that diagnostically you are at an impasse, it may just be that you had these isolated episodes of optic neuritis and that nothing further will occur in the future.
The other symptoms you describe – including nystagmus, blurringand double vision – may or may not be related to the optic neuritis. With a normal MRI, it may be difficult to have a specific explanation for these symptoms and likely the appropriate course of action will be to wait and watch. Unfortunately, many times we cannot give a specific answer if we do not have abnormal findings or an abnormal MRI.
Hopefully, the attacks of optic neuritis are isolated and your risk of developing MS in the future is low, given your normal MRI.