Question
I has a general eye test as I had been having falls, unsteady gait etc (I am F, 42, obese - but only for past 10 years, have many children, but now hysterectomy - bloods state - not menopausal). My vision was fine - i.e. no glasses needed, but a visial field test - repeated days apart for accuracy, shows a loss of peripheral vision. I also got daily headaches - severe - worse in the AM, and on standing, and have had empty sella identified by MRI along with "high T2 foci within brain" and CSF in sella. I make way too much prolactin, no Human Growth Hormone, and borderline hypothyroidism.
An otho-neurologist used a table slit lamp (I think) and said I had "chronic swelling of the retinal discs(?)". I now have to have a lumbar puncture and more MRIs and MRVs.
What is this chronic swelling?
What causes peripheral vision loss?
Could I go blind?
What does "high T2 foci in brain" mean?
Can the eye thing - and clumsiness, misjudging distances, photophobia etc, be related to the empty sella? Or is that more an eye thing....and if so....what?
I am scared and it seems a lot of info but not a lot of explanation.
I truly hope someone takes the time to try and answer this - I know it crosses enrocrinology & neurology boundaries as well as opthalmolgy. That doesn't help make it any easier to "get it" !
I'm scared. 42 is very young to go blind !!!!
Thank you.
Answer
The condition Pseudotumor Cerebri is most common in middle aged women and is associated with obesity and pregnancy. The syndrome consists of elevated intracranial pressure, chronic swelling of the optic nerves, headaches, transient visual disturbances, and visual field loss, usually temporary.
It can be treated with oral diureitic preparations and with serial lumbar puncture (spinal taps) to decrease the intracranial pressure. Most patients do well and the condition resolves, but some patients do have some permanent visual field loss.
The condition is best managed by a neurologist and an ophthalmologist working together, using serial examinations and serial visual fields.
The empty sella syndrome and abnormal MRI are conditions usually UNrelated to Pseudotumor, and are best followed by your endocrinologist and neurologist.
