Question: I have been having bad headaches for the past 4 weeks. I feel that my head in under a lot of pressure and when I move it to the left or right it hurts a bit more. I have recently, over the past two weeks, had pain behind of my eyes also. Approximately 5 days ago, I lost my vision for approximately 30 seconds and I seem to have lost a little bit of my periphery vision. It also hurts when I look to the extreme left/right/up/down. During this period I have been feeling tired and lethargic also. 3 days ago, I felt so lightheaded and fainted for approximately 40 seconds. After struggling with all of these issues, I have decided to go see a neurosurgeon. An MRI was performed, and I need a second opinion on the diagnosis: Empty Sella, tortuous optic nerves and prominent perineurual CSF sleeve, likelihood of idiopathic intracranial hypertension.

Hello Dr.-

More so than the headache, it's the feeling of lightheadedness that troubles me the most and my on-going sensitive to loud noises and bright lights, and pain behind of my eyes.

Many thanks for responding so quickly! Here are some quick responses to your questions above:

1. No fever? No fever.

2. No nausea or vomiting? I have felt nauseous during this period.

3. Is there neck tightness/pain? No.

4. Are these headaches nearly constant? No they come and go at different times in the day.

5. Are you more sensitive to noise than lights? Yes I am more sensitive to noise and lights of recent.

6. In the past few weeks, along w these headaches do you feel dizzy, lightheaded?? Yes, this is my biggest problem. I nearly collapsed a few days ago, because I felt lightheaded. I think this is one of my primary problems along with PAIN behind the EYES.

We did an endocrine profile to test pituitary function, here are the results:

PM Cortisol: 2.48 (2.3 - 11.9)
AM Cortisol: 6.51 (6.2 - 19.4)
Testosterone: 4.03 (2.8 - 8)
Prolactin: 6.02 (4.6 - 21.4)
T3: 2.98 (2 - 4.4)
TSH: 1.44 (.27 - 4.2)
T4: 1.50 ( 1.04 - 1.65)

Antinuclear Antibodies: Negative
RA Factor: Negative

ESR: 10 (0-9)
WBC: 7.76 (4-10)
Platelets: 338
Haemoglobin: 15.8

I have also attached a few other MRI pics.

Additional questions:

1- Have you reviewed the actual MRI's and not the report? What are you thoughts?

2- DO you suspect IIH? if so, why?

3- Do you see any lesions or cause for concerns?

4- Do you actually see a tortuous optic nerve? If so, what are are causes?

I wanted you to provide an independent view, and not necessarily base your response on the MRI report.

Are you ruling out lesions and or brain cancer?


Dr. I have uploaded the CD's for your final review.

https://drive.google.com/file/d/0B0hTLnojqoLbakZ6OVg4OXhlVVU/view?usp=sharing

Thanks for your patience Dr. This has been a confusing time for me:

I have a few last follow-up questions:

1-Would these finding all be incidental? Are these issues congenital? Would I have been living with this for a while? I had a bathroom fall 3 months ago, and hit my head pretty hard on the bathroom floor, could this a symptom of that? I am sorry for asking some many questions, however, I am shocked that there are abnormal findings and that Dr's. don't know the cause.

2- Is there anything life threatening? Should I have these tests done quickly?

3- Also, I have noticed that my brain feels foggy. I don't remember things like I used to and I don't feel like my brain is clear or as sharp as it used to be. I am a bit forgetful of recent, could this be symptom if IIH?

4- I am also feeling a bit dizzy, could this have anything to do with the IIH that I am experiencing?

5- What will the fundoscopy tell me?

6- How evasive is the CSF fluid removal? Would you recommend this procedure? How long will it take? Will I be able to return to normal activities quickly?

7- What are some good neurological centers in XXXXXXX or other parts of India?

Hello Dr.-

Did you notice any small FLAIR hyperintensities in the midbrain and around posterior horns of lateral ventricles?

thanks