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The Doctors Lounge - Primary Care Answers

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Forum Name: Eye diseases (Ophthalmology)

Question: Short term sight loss plus balance problem


JCMF - Thu Feb 03, 2005 9:40 pm

I was generally looking about the internet for answers when I came across this site, maybe somebody here can help.
For over a year & a half now I have been having sight problems, I become light headed & lose sight in either my left eye or to some degree both. There will be a feeling of pressure in my head & a high-pitched whistling sound in both ears. The sight loss will only last about 3 or 4 minutes but it is usually accompanied by a loss of balance & some degree of disorientation, not good for a teacher in class.
I have seen a doctor & been sent to a neurologist, who in turn sent me to have a scan, which showed nothing wrong. The neurologist prescribed anti depressants & when I ask why he told he did so because my Spanish is so bad. I am English living in Spain. I pointed out that my wife is Japanese & it is her language that I am studying most, not Spanish. Neither of the doctors I have seen have made any physical contact with me so can have no idea about blood pressure or anything else. I have also not been asked if I smoke or drink. This does not inspire me to trust or go back. Any thoughts would be a help. Thank you, JCMF
angelseakr - Fri Feb 04, 2005 3:41 am

Dear JCMF,
I am certainly not an expert in this problem so please excuse me but your post reminded me of something that happens to my mother. She will get flashes of lights in her vision field and then will loose partial site for a short period of time. Her physician diagnosised her with migrains even though she does not have any pain prior to or after this episode. Here is something I found on the web. perhaps it will help you explore your situation further.
The aura of migraines
The two main types of migraines are those that occur without aura or those that occur with aura. Aura refers to an array of psychologic or neurologic disturbances that occur shortly before migraine onset. Compared to migraine without aura, migraine with aura is the less common type, but it is perhaps more medically intriguing, and for patients who get them, more unsettling. (Aura also can occur without a subsequent migraine, a factor that can result in mischaracterization of the migraine type. More on this below.)

Auras typically last 5 to 20 minutes and involve symptoms such as vertigo (motion sickness or dizziness), imbalance, confusion or numbness; but most auras consist of visual disturbances such as partial vision loss, the appearance of "special effects" and distortion of objects. Sometimes the visual effects can be dramatic, says Dr. Mays—flashing lights, complex color patterns and shapes (e. g., triangles and dots), and floaters (the perception that some tiny foreign object is floating across the eye). An individual might also see shimmering or zig zag lines in the peripheral vision and blurriness in central vision.

The "one-eye" migraine
In a related condition called ocular migraine, which is even less common than migraine with aura, individuals experience the same visual disturbances that occur during an aura, but the symptoms only occur in one eye. The aura that occurs before an ocular migraine is commonly followed by a migraine Headache. And the same triggers that can bring on migraine with or without aura also can cause ocular migraine.

Ocular migraine can produce various degrees of vision loss or obstruction. Some patients, says Dr. Mays, report blind spots or "holes," referring to missing sections in the normal visual field, or they may experience a shade of black or gray over the visual field. Some people compare the visual phenomena of ocular migraine to the patterns produced by an old television with faulty reception, says Dr. Mays. "Others say it’s like looking through watery glass."

Ocular migraine symptoms are temporary and do not harm the eye; but they can interfere with daily activities, such as reading and driving and can interrupt the work day.

Fear about vision loss caused by ocular migraine often leads an individual to seek medical care, says Dr. Mays. In some cases, the first stop is the ophthalmologist’s office. That’s fine, says Dr. Mays, but people diagnosed with ocular migraine should also see a neurologist so that conditions such as Stroke, which can cause similar visual symptoms, can be ruled out and so that the migraine itself can be effectively managed. Other conditions that produce ocular-migraine like symptoms include retinal artery thrombosis (blood clot in a vein inside the eye) and, as noted, migraine with aura.

Confusing auras
Although ocular migraine and migraine with aura are very similar experiences, one key difference is the source of the vision disturbances. In migraine with aura, the occipital cortex of the brain is the source of vision disturbances. In ocular migraine, it is the retinal blood vessels inside the eye. The retina is the thin lining on the back, inner part of the eye that prepares images for processing by the brain. An individual experiencing the aura of ocular migraine could cover or close one of the eyes and stop the symptoms. Not so for an individual experiencing traditional aura. "The symptoms affect both left- and right-sided vision," says Dr. Mays. "The source of the problem is the brain, not the eyes."

For some reason, says Dr. Mays, auras that occur without a subsequent migraine often get labeled—by patients and physicians—as ocular migraines. She speculates that it’s a combination of a lack of knowledge about migraines and the notion that if there are visual problems but no migraine, it must be an "eye," or ocular, problem.
JCMF - Fri Feb 04, 2005 1:43 pm

Angelseakr,
Thank you, your post comes very close to describing the problems I am having. I had discounted migraine reasoning that it would not affect one eye while not affecting the other, it seems I was wrong. I do avoid things like drink, chocolate & sweet things in general because these will bring on a Headache, as will sleeping more than 4 or 5 hours. The head aches didn’t (& don’t) seem to be related to the loss of sight, which as you describe is more like a grey cloud that blocks out the central area of sight. The “normal” pattern of attack will be lightheadedness & a general distubance of vision to the point that I need to sit down, this then is followed by one or both eyes clouding over. The pressure in the head, near the temples, will at this point be incredible, but in small classes I can usually bluff my way through, though to what degree it is not noticeable I really don’t know.
I think that this really does fit very closely to what you posted.
I think, on re-reading, that I should add that my first post was not a critique on Spanish doctors, I do have Spanish doctors who are friends & they are excellent, but they will not of course say a word about others that may be a little less than excellent.

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