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What Causes Bilateral Optic Disc Swelling?
Question: My opthamologist during dilation told me that I have optic nerve swelling bilateral and because I reported headaches and vision changes nausea and balance issues, he told me to be seen for pseudotumor cerebri. I went to my regular Dr and he ordered an MRI with and without contrast no diffusion weighted imaging performed is what it says. The radiology reports no abnormalities with the exception of moderate fluid signal intensity within the right mastoid air cells the left air cells are clear. Would this cause the optic nerve swelling ? And should I be concerned about the fluid intensity in the right mastoid?
Brief Answer:
Possible Pseudotumor cerebri?
Detailed Answer:
Hello. My name is Dr. Saghafi and I am an adult neurologist in XXXXXXX Ohio.
The recommendation by the ophthalmologist is certainly not a bad one given your symptoms of bilateral optic disc swelling. That is seen many times in what is now called IDIOPATHIC INTRACRANIAL HYPERTENSION or IIH (formerly pseudotumor cerebri).
MRI is a good test to get and no diffusion weighted imaging is necessarily needed and that will give some very good information and add some support to a diagnosis of IIH, however, in addition I would get a PHASE CONTRAST sequence which can detect subtle points of possible obstruction to the flow of cerebrospinal fluid which can cause the picture you are suffering.
I would recommend seeing a neurologist to solidify this diagnosis because what they will need to do is a spinal tap to get an opening pressure so you want them to be absolutely sure there is no mass lesion to deal with in the head before doing a tap.
The mastoid air cell thing that the radiologist is calling has no significance to your problem and cannot be the cause of bilateral optic disc swelling.
I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.
Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this interesting discussion.
Please keep me informed as to the outcome of your situation.
All the best.
The query has required a total of 60 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Possible Pseudotumor cerebri?
Detailed Answer:
Hello. My name is Dr. Saghafi and I am an adult neurologist in XXXXXXX Ohio.
The recommendation by the ophthalmologist is certainly not a bad one given your symptoms of bilateral optic disc swelling. That is seen many times in what is now called IDIOPATHIC INTRACRANIAL HYPERTENSION or IIH (formerly pseudotumor cerebri).
MRI is a good test to get and no diffusion weighted imaging is necessarily needed and that will give some very good information and add some support to a diagnosis of IIH, however, in addition I would get a PHASE CONTRAST sequence which can detect subtle points of possible obstruction to the flow of cerebrospinal fluid which can cause the picture you are suffering.
I would recommend seeing a neurologist to solidify this diagnosis because what they will need to do is a spinal tap to get an opening pressure so you want them to be absolutely sure there is no mass lesion to deal with in the head before doing a tap.
The mastoid air cell thing that the radiologist is calling has no significance to your problem and cannot be the cause of bilateral optic disc swelling.
I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.
Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this interesting discussion.
Please keep me informed as to the outcome of your situation.
All the best.
The query has required a total of 60 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Were you able to read my mri radiology document? And even though my Mri didn't show anything abnormal you still think I should have a lumbar puncture? And it's still possible I could have the IIh? Because it said there was no cerebral edema I thought I was in the clear with that.
Thank you
Thank you
Brief Answer:
Still can have IIH
Detailed Answer:
By no means is a normal MRI a guarantee that IIH does not exist. What I am disappointed in the MRI read really is something that convinces me that the radiologist reading the study actually looked for specific signs that are typically looked for in an MRI of a patient suspected as having IIH.
I believe a NEUROLOGIST should look and lay hands on you and your case before performing a lumbar puncture but if it were my call and IF I truly believed that IIH were a possibility I would get the Phase Contrast MR study as well as an MRV (Magnetic Resonance Venography). Then, I would retake the history and do a very detailed neurological examination especially of eye movements to look for signs of increased pressure inside the head.
If MR studies were still not conclusive or even negative I would still seriously thinking about the lumbar puncture because that is the MOST ACCURATE diagnostic method to make the diagnosis of intracranial hypertension.
Also, I would consider doing Visual Fields testing using a Humphrey Tester.
Here is just a short list of other possibilities if not IIH:
obstructive hydrocephalus, arteriovenous fistula, internal jugular vein stenosis, and dural sinus thrombosis.
I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.
Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this interesting discussion.
Please keep me informed as to the outcome of your situation.
The query has required a total of 85 minutes of physician specific time to read, research, and compile a return envoy to the patient.
All the best.
Still can have IIH
Detailed Answer:
By no means is a normal MRI a guarantee that IIH does not exist. What I am disappointed in the MRI read really is something that convinces me that the radiologist reading the study actually looked for specific signs that are typically looked for in an MRI of a patient suspected as having IIH.
I believe a NEUROLOGIST should look and lay hands on you and your case before performing a lumbar puncture but if it were my call and IF I truly believed that IIH were a possibility I would get the Phase Contrast MR study as well as an MRV (Magnetic Resonance Venography). Then, I would retake the history and do a very detailed neurological examination especially of eye movements to look for signs of increased pressure inside the head.
If MR studies were still not conclusive or even negative I would still seriously thinking about the lumbar puncture because that is the MOST ACCURATE diagnostic method to make the diagnosis of intracranial hypertension.
Also, I would consider doing Visual Fields testing using a Humphrey Tester.
Here is just a short list of other possibilities if not IIH:
obstructive hydrocephalus, arteriovenous fistula, internal jugular vein stenosis, and dural sinus thrombosis.
I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.
Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this interesting discussion.
Please keep me informed as to the outcome of your situation.
The query has required a total of 85 minutes of physician specific time to read, research, and compile a return envoy to the patient.
All the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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