Young woman who would lose eyesight in left eye each time she took hot water bath
1. 25-yr old woman consulted me with complaints of losing #vision in left eye after hot water bath. This had occurred 8 times in the past one month. Vision would get restored in a few hours on own.
1. 25-yr old woman consulted me with complaints of losing #vision in left eye after hot water bath. This had occurred 8 times in the past one month. Vision would get restored in a few hours on own.
2. Short-duration loss of #eye sight had occurred last Winter too, but she ignored them.
Last week, she was taken for an #ophthalmological examination after one such episode, and no abnormality was detected.
Her family members thought she was making up her symptoms.
#MedTwitter
Last week, she was taken for an #ophthalmological examination after one such episode, and no abnormality was detected.
Her family members thought she was making up her symptoms.
#MedTwitter
3. She requested her husband to take her for further expert medical opinion, which he refused.
But the woman was convinced that her symptoms were for real, as she had definite loss of vision in left eye after hot water bath.
So, here she was in my OPD, against her family's wish
But the woman was convinced that her symptoms were for real, as she had definite loss of vision in left eye after hot water bath.
So, here she was in my OPD, against her family's wish
4. On detailed enquiry, she also reported similar loss of vision in left eye after her Zumba sessions. Again the loss of vision would last a few hours after the exercise, and return to normal in a few hours. She reported occasional "pins and needles" sensations in hands and feet.
5. By now, it was clear what the woman was suffering from. This phenomena had been described by an #Ophthalmologist 132 years ago.
I ordered for two investigations to confirm my suspicion- VEP (visual evoked potential) studies and #MRI (#brain & spine).
#NeuroTwitter
I ordered for two investigations to confirm my suspicion- VEP (visual evoked potential) studies and #MRI (#brain & spine).
#NeuroTwitter
6. She returned the next day with reports and the diagnosis was confirmed.
VEP studies showed features of optic nerve dysfunction and MRI was diagnostic for multiple sclerosis (MS).
I discussed the treatment plan with her (& husband).
#MultipleSclerosis
VEP studies showed features of optic nerve dysfunction and MRI was diagnostic for multiple sclerosis (MS).
I discussed the treatment plan with her (& husband).
#MultipleSclerosis
7. Transient loss of vision on exposure to heat is referred to as #Uhthoff's phenomenon (eponym taken from the surname of the Ophthalmologist, who first reported it in 1890).
Patients with MS are advised to avoid exposure to heat in order to prevent worsening of symptoms of MS.
Patients with MS are advised to avoid exposure to heat in order to prevent worsening of symptoms of MS.
8. Take home message
*Short duration loss of vision after hot water bath or exposure to hot sun in a young person (aged 15-60 years) could be a symptom of multiple sclerosis.
*Careful clinical assessment and investigations can establish the diagnosis.
*Short duration loss of vision after hot water bath or exposure to hot sun in a young person (aged 15-60 years) could be a symptom of multiple sclerosis.
*Careful clinical assessment and investigations can establish the diagnosis.
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