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Should Steps Be Continued For Symptoms Of Optic Neuritis While Experiencing Pain In The Head And Itching In The Legs?

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Posted on Sat, 2 Jun 2018
Twitter Sat, 2 Jun 2018 Answered on
Twitter Tue, 14 May 2024 Last reviewed on
Question : I woke up on Tuesday morning and am not really able to see out of my left eye. It is very hazzy. All letters in the middle are completely gone. There is a little vision on the edges and I can kinda see shapes. I had no injury. I went to bed fine and woke up with a messed up left eye. Since I had had the low grade fever off and on and had the vaginal spotting...which I had again this morning then I went straight to an eye doctor. (see last two questions I did on here in the last month) The eye doctor got me into an eye specialist within 45 minutes who said my optic nerve was very swollen and misshappen. He said he's been doing this for 31 years and hadn't seen it like this. He said I had a swollen optic nerve with chronic gliosis. He said it didn't look like it had just happened. He sent me to my PA with a plan of action to start me on Prednisone 80 mg for 3 days, then 60 mg for 3 days and then 40 mg. He wanted blood work done and wanted me to see a neurologist for possible lumbar puncture and MRI of the brain. I went that evening to the doctor and he did bloodwork and I started Prednisone. The next day I was no better. Bloodwork came back normal. I called the eye specialist back and he wanted a retina specialist to take a look at me for a second opinion. This is a doctor who works in that office 1 day every two weeks. I went in and the specialist said Neuro-retintis. I really had no improvement in the 1 1/2 days on Prednisone so he took me off and said he thinks it is cat scratch fever. I don't see that I have any symptoms of that and have't been scratched or bitten by my cats but who knows. He said he needed more blood work done. He ordered RPR, FTA_ABS, Cat scratch titer, ACE, Quantiferon God, ESR, CrP and Chest X ray. I am now off the Prednisone and he started me on a Zpack. I started that yesterday morning and I feel only worse. My head feels like it is in a vise. My eyesight seems worse. When I went to the doctor on Thursday my eyesight in the good eye had gone down 2 lines on the reading chart for checking eyesight. I am tied but nothing too severe. The doctor's office told me today that the blood work won't be back until at least Wednesday. I am not sure if I should go back on the Prednisone or not. The first doctor thought I definitely needed to get the swelling down. The second doctor is convinced this is cat scratch fever and that the prednisone will make it worse. I feel like I am getting worse and Monday is a long way off. The second doctor wasn't sure if I would need the MRI of the brain which is scheduled for Tuesday. I don't want to spend unnecessary money as this is out of pocket but I don't want to prolong this and get any permanent damage done to my eye. I am not sure what is going on and what to do. I have no scratches or anything like that. The assessment is optic papillitis, left eye: H46.02 . OU. condition moderate I have never had trouble with my eyes before. I do not have pain when my eye moves. What advice can you give me?
It's been several hours. Do you have any kind of advice for me? My head is hurting and the top of it is tender to the touch. I am concerned and would like to hear back from you. One other weird thing that happened to me this week is that my legs were very, very itchy one morning soon after waking up. It was a nerve kind of itch on both legs below the knees if I remember correctly. I had forgotten about it until this evening. Anyway, I sure am anxiously awaiting a reply.
doctor
Answered by Dr. Shinas Hussain (6 hours later)
Brief Answer:
Continue steroids.

Detailed Answer:
Hello,
Thanks for query.
As per your description your symptoms are suggestive of optic neuritis. It can be caused by many conditions and unfortunately it can happen without any obvious cause and in that case we will call it as idiopathic.
Steroids are the mostly prescribed drugs for this condition and most patients improve with predenisolone. Cat scratch disease is a remote possibility and you can start on doxycycline empirically after discussing with your doctor. However it would be better to continue steroids as cat scratch is a rare possibility.
MRI must be taken because we can rule out conditions like anterior ischaemic optic neuropathy (AION) by MRI.
Continue the current line of management according to the protocol.
Wishing you good health.
Thanks



Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Shinas Hussain (57 minutes later)
Thank you for your answer. I felt like I should go back on the steriods too.
Do I stop taking the z pack? I have taken it for 2 dAYS now or do I take both the z pack and the steroid. I will go take the steroid now.

Is it true that optic neuritis is associated with MS.

As I read on optic neuritis the description certainly fits me a lot more than Cat Scratch Fever although I wish that were not the case. I don't know much about MS but I know that is not something I want at all!

I read on the AION and it sounds like a good possibility as well. I will get the MRI as planned to narrow things down. Thank you for your reply.
doctor
Answered by Dr. Shinas Hussain (1 hour later)
Brief Answer:
You can take Zpack and steroids together.

Detailed Answer:
Thanks for the query.
Zpack is antibiotic pack containing azithromycin. Both steroids and Zpack can be taken together. Zpack is added because of the possibility of infectious origin like cat scratch disease.
Unfortunately multiple sclerosis is the most common cause of optic neurits. But it generally appear after age of 50.
Get MRI done at the earliest for further evaluation:
Thanks
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Shinas Hussain

General Surgeon

Practicing since :2015

Answered : 23649 Questions

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Should Steps Be Continued For Symptoms Of Optic Neuritis While Experiencing Pain In The Head And Itching In The Legs?

Brief Answer: Continue steroids. Detailed Answer: Hello, Thanks for query. As per your description your symptoms are suggestive of optic neuritis. It can be caused by many conditions and unfortunately it can happen without any obvious cause and in that case we will call it as idiopathic. Steroids are the mostly prescribed drugs for this condition and most patients improve with predenisolone. Cat scratch disease is a remote possibility and you can start on doxycycline empirically after discussing with your doctor. However it would be better to continue steroids as cat scratch is a rare possibility. MRI must be taken because we can rule out conditions like anterior ischaemic optic neuropathy (AION) by MRI. Continue the current line of management according to the protocol. Wishing you good health. Thanks