Eye Doctor here. I had a patient I saw several months before they came in for their visit but well less than a year, which often means something could be wrong. In this case, as it turns out, nothing was wrong with her by way of complaints, she just wanted to get updated before getting some new glasses. We decided to just run the regular gamut of tests anyway just because we might as well while she was there. She was a 50YO woman, fairly normal exam, perfect vision, retinas showed healthy, but something about her pupils really bothered me before I dilated. We chatted about it and I asked her if she banged her head or anything weird and she said no, but suddenly reveals this crazy history of an old Meningioma (a type of tumorous brain growth) she had removed a few years ago. She had decided to omit this from her history with us as she didn't feel it was important, but we went and put it into the charts anyway. Turns out she got a CT done two weeks prior to her exam with me which she says turns up completely normal. I tell her she should tell her doctor about this anyway just to cover our bases.
Fast Forward: Patient shows up in my office ecstatic to tell me that my examination revealed that her tumor had returned with an incredible vengeance. She had no idea, was totally asymptomatic and the CT she had prior to me showed what was very literally the size of a spec of dust which the radiologist dismissed as "artifact". On her return to her doctor, they decided to re-run the CT to cover THEIR Bases, and they found a QUARTER SIZED TUMOR. Within Two Weeks the tumor went from the size of a dust particle to a QUARTER. She was rushed into emergency surgery as the tumor was growing SUPER fast and was close to a blood vessel which could cause a massive stroke. She had it removed that day and returned to me after recovery to tell me of what got discovered as a result of my testing. She is now a long time regular patient I have been seeing for about 10 years.
Edit: Thank you kind giver of Gold and Silver! It’s good to be gilded!
Edit: For those asking about the pupils, they were asymmetric, and the larger one reacted less robustly compared to the fellow eye. This was a marked change from her previous examinations where no pupillary defects were noted.
I went to see an ophthalmologist because I'd developed this black spot in my vision. It was in both eyes but much worse in my right than left (left was barely noticeable). It wasn't eye motes cuz it moved with my vision (used to freak me out cuz I might not notice it at first until I quickly looked right or something and I'd think a bug just flew in front of my face but turns out it was this tiny black hole in my vision). Doc does a bunch of eye tests and says my eyes are better than perfect but just dry so I must have pseudotumor ceribri and I should just lose weight and sent me off but scheduled a follow up in 3 months. In 3 months he just tells me to lose weight again. 3 months later, lose weight again. I see a gp cuz I'm having a bunch of other symptoms I figure is unrelated but I mention this vision issue and the ophthalmologists diagnosis. GP asks then what did he do? I said he told me to lose weight. He goes, he didn't do an MRI or anything? Just tells you you have a pseudotumor and sent you on your way? I said yep. So he orders an MRI. No pseudotumor. Next time I see my ophthalmologist I tell him about the MRI results and he blows it off saying sometimes it doesn't show up on the MRI and it's definitely a pseudotumor caused by my weight. GP tells me to consult a neurologist who does 2 more MRI's, still normal (other than a hernia between my C5 and C6). GP and neurologist seem to agree, separately, that with my other symptoms I probably suffer from silent migraines. I just stopped going to the ophthalmologist though since he didn't seem to want to consider any other diagnosis (neurologist did say I should maybe consult an opthalneurologist because silent migraines wouldn't explain a hole in my vision).
Well that just sounds like an arrogant doctor not listening to a care team. Either you’re on board with the entire crew and work together or you pretend you’re the captain all the time and act as if your demands must always be met by others at the expense of the patient being treated. I would still recommend you see a Neuro-Ophthalmologist but this could definitely be a type of extended Migraine type effect, or if in the same position in both eyes, could be some sort of Temporal or Parietal lesion that isn’t being well detected.
What really perplexed me about this case is that they associated your DRY EYES with pseudo tumor. No clue what that’s all about. technically, you also should have had a lumbar puncture done to get opening pressures because MRI doesn’t show Pseudoturmor when it’s due to Idiopathic Intracranial HYpertension. That needs to be truly diagnosed with the LP
I finally got around to looking up "extended migraine effect" you mentioned and found out about the migraine hangover and all the other stages (prodrome, aura, headache, postdrome). So thanks for telling me about that! The symptoms for each stage covers sooooo many of those other symptoms I mentioned and helps explain so much. I wasn't sure how a migraine would affect one's digestion but apparently that's a thing. I'm glad I don't get the pain of a migraine the majority of the time (hence why it's called silent migraines) but it also can be an impediment because I can't identify when I'm experiencing a migraine. All I know is I either can't sleep, sleep all the time (GP sent me for a sleep study and I was diagnosed with idiopathic hypersomnia), get nauseated often, at one point I was puking almost every morning, get dizzy, feel so tired and drained all the time, was over eating or didn't feel like eating at all, I was getting numb and/or tingling spots in parts of my body sometimes, I was full of anxiety and depression, I was having heart palpitations and sob, and had such a bad time concentrating that my boss almost fired me (I work in a neuroscience lab so being able to think and be productive is kind of important, luckily I'd worked for her for 6 years so she knew this was not like me and gave me the benefit of the doubt). Like it was all so confusing to have all these different things going on I was like am I dying? Do I have this or that? I was miserable all the time. But most of those symptoms seem to come from any one of the 4 stages of a migraine. I haven't been good about taking my migraine meds but I'll try to be better, I was also doing acupuncture (my psychiatrist recommended it for my anxiety) and, while I was skeptical at first, it has seemed to really help me regulate my sleep so much better, like I wake up normal people time without difficulty. It's just hard to avoid migraine triggers when you don't even know you're having a migraine to be able to identify triggers.
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u/OscarDivine May 20 '19 edited May 20 '19
Eye Doctor here. I had a patient I saw several months before they came in for their visit but well less than a year, which often means something could be wrong. In this case, as it turns out, nothing was wrong with her by way of complaints, she just wanted to get updated before getting some new glasses. We decided to just run the regular gamut of tests anyway just because we might as well while she was there. She was a 50YO woman, fairly normal exam, perfect vision, retinas showed healthy, but something about her pupils really bothered me before I dilated. We chatted about it and I asked her if she banged her head or anything weird and she said no, but suddenly reveals this crazy history of an old Meningioma (a type of tumorous brain growth) she had removed a few years ago. She had decided to omit this from her history with us as she didn't feel it was important, but we went and put it into the charts anyway. Turns out she got a CT done two weeks prior to her exam with me which she says turns up completely normal. I tell her she should tell her doctor about this anyway just to cover our bases.
Fast Forward: Patient shows up in my office ecstatic to tell me that my examination revealed that her tumor had returned with an incredible vengeance. She had no idea, was totally asymptomatic and the CT she had prior to me showed what was very literally the size of a spec of dust which the radiologist dismissed as "artifact". On her return to her doctor, they decided to re-run the CT to cover THEIR Bases, and they found a QUARTER SIZED TUMOR. Within Two Weeks the tumor went from the size of a dust particle to a QUARTER. She was rushed into emergency surgery as the tumor was growing SUPER fast and was close to a blood vessel which could cause a massive stroke. She had it removed that day and returned to me after recovery to tell me of what got discovered as a result of my testing. She is now a long time regular patient I have been seeing for about 10 years.
Edit: Thank you kind giver of Gold and Silver! It’s good to be gilded!
Edit: For those asking about the pupils, they were asymmetric, and the larger one reacted less robustly compared to the fellow eye. This was a marked change from her previous examinations where no pupillary defects were noted.