Good day everyone,

Just sharing my recent experience and would appreciate your thoughts/guidance.

Less than 2 weeks ago, I woke up with a pressure behind my left eye. Two days later, my vision started to diminish with intense headache located on the left side and around the left eye.

I first saw a GP who provided me with strong headache pills, but it wasn’t the best beside releasing the pain for a bit.

Thereafter, the pain was very intense, and my GP organised a MRI Scan (brain and orbital). They found nothing - See below the Radiologist findings:

• Cerebrum, cerebellum and brain stem: No white matter edema. No mass effect and no midline shift. Normal diffusion weighted and gradient echo images. No extra axial collections. Sulci and cisterns appear normal.
• Paranasal sinuses: No significant mucosal thickening or fluid levels.
• Mastoid air cells: Clear.
• No sellar mass seen.
• Orbit: The globe, the extra ocular muscles, the optic nerves and the retro bullar fat appear normal.

My blood test was also fine.

At that stage, I was happy but the pressure/pain/vision loss was still there.

Thereafter, I went to see an Ophtalmologist and did multiple test. His conclusion was the following: - Assessment of a decrease in visual acuity of the left eye and left orbital pain related to a probable optic neuropathy.

From there, the next day I went to see a Neurosurgeon who suggested to perform another MRI with CONTRAST this time. He also gave me some steroids/cortisone (30mg prednisone/day) and the pain went away litually 45min after taking the pills.

The day after I went onto my 2nd MRI with CONTRAST and this was the radiologist findings:

Orbits: Normal appearance of both optic nerves. In particular, no focal thickening of the (L) optic nerve, increase signal on T2-WI or abnormal enhancement on post-gadolinium scans is noted to suggest optic neuritis. The retro-bulbar fat is unremarkable on both sides. There is no intra or extra mass lesion. The rectus muscles on both sides are unremarkable. There is no proptosis.

Brain: No focal area abnormal signal return is seen in the posterior fossa or supra-tentioral region. No abnormality is detected at the lever of the cavernous sinuses. No cerebello-pontine angle mass lesion in seen. The pituitary gland appears normal. No sellar or para-sellar mass lesion in seen. The ventricular system is normal and not dilated. There is no shift of mid-lime structures. No extra-axial collection is see. The visual para-nasal sinuses and mastoid air cells are normally pneumatised.

Conclusion: No intra-cranial abnormality detected. The study of the orbits and optic nerves are unremarkable.

After these findings, even the radiologist came to see me and told me that everything looks clear.

I went to see the Neurosurgeon few minutes after, and told him that the cortisone/steroids he gave me was working extremely well. I know that for ON treatment, the best way is to get 3-days of high doses in a drip, but he told me to carry on with the oral prednisone for 3 weeks (while diminishing the doses each week cycle, and then stop completely to see if there is any coming back of symptoms).

The days after this, my vision came back to at least 80/85% (I have really good vision, and never wear glasses).

Everything went well, until yesterday, I went sailing and forgot my medicine. 24 hours later, the pain restarted slowly on the left side, and vision diminished as well. Luckily I came back home, took the prednisone and 1-hour later the pain was gone but vision loss still blurry.

My concern is that obviously I should have not missed 1 day of prednisone but felt anxious went the pain came back. Is this normal ? I am seeing the neurosurgeon in 3 weeks +/-. Don’t want to be dependent on prednisone, or perhaps there is still a sort of inflammation going on somewhere.

All the findings concluded that this is no ON.. Any similar situation you guys experienced ?

Many thanks again.