Something Seemed to Be Blocking Signals to Her Brain. What Was It?

You can’t see the ceiling, can you? the man asked his 31-year-old wife.

She winced, then shook her head. She lay in bed and stared at the familiar shadows and shapes cast by the winter morning sun. But she couldn’t see them. It was like a thick white mist between her and these daily shifting patterns. Squinting didn’t help. Opening her eyes as wide as she could, she didn’t either. All her life she had perfect vision. It was a secret source of pride. She had never even been to an optometrist. But that morning changed everything.

She first noticed problems in her eyes six months ago.

She is a professional violinist and teacher and took her students to Italy that summer to experience sacred music and art. As she stared at the frescoes that adorned the ceiling of her beloved cathedral, a shimmering figure with jagged, jagged edges appeared out of nowhere. The dots seemed to flicker as the star image slowly enlarged. Inside the glittering outline, the colors jumbled like crystals in a kaleidoscope. It was beautiful and scary. She lowered her head, closed her eyes, and rubbed her aching neck.

When she opened her eyes

The flickering-edged star was still there, distorting everything beyond it. It got so big that it was almost all she could see. Then slowly it began to disappear; nearly half an hour later, the world began to take on its familiar shape and form. There were similar, though less severe experiences: from time to time, when she got up quickly after sitting down or lying down, she felt a strong pressure inside her head, and when it eased, everything looked faded and pale for a short time. return to normal shades. These spells only lasted a few seconds and only happened a few times over the past few years. She chalked it up to fatigue or stress. After that day in Italy, these brilliant flashes of stars appeared weekly and then daily.

Even stranger

straight lines formed odd bumps and bumps when she looked at them out of the corner of her eye. Doorways, curbs and table edges seemed to wobble, bulging and hollowing. When she looked at the object at its full height, it obediently straightened up, but reverted back to aberration when it was out of the way again.

A few days after the morning whiteness, the young woman went to see an optometrist in nearby Fort Lee, New Jersey, Dr. Paul Shahinian. If the starbursts bothered the young woman, then Shahinyan’s reaction to her exam was horrendous. He told her that she needed to see a neuro-ophthalmologist – an eye and brain specialist – and she needed to see him soon. All the information gathered by sight is transmitted to the brain through a thick cable of fibers at the back of the eye called the optic nerve, the doctor explained, and the nerve in her left eye was badly swollen. While she was sitting in his office, Shaginyan himself called in the experts. The first two offices he called gave the same answer: she couldn’t make an appointment for months. He then approached a neuro-ophthalmologist who was new to the area, Dr. Kaushal Kulkarni, and after explaining the urgency, made an appointment to see the patient the following week.

Kulkarni listened as the patient described her strange visual anomalies. Although her vision was still 20/20, the intermittent starbursts and curved lines seen in her peripheral vision—a phenomenon known as metamorphopsia—suggested that something was wrong with the way her brain received and processed visual information. . Kulkarni shone a narrow, bright light into the young woman’s right eye. As expected, both pupils contracted. He moved the light to the left, and both pupils immediately dilated. Sliding it to the right, her pupils constricted again; returning to the left, they suddenly widened again. Obviously, the signal on the left did not pass. The swelling blocked the flow of information from the eye to the brain. However, this seemed to be a one-sided problem: the fact that the left pupil constricted when light entered the right eye indicated that information from the brain was still coming in.

There are many reasons for this kind of damage to the optic nerve.

Shahinyan thought that, given the age of the patient, it was probably multiple sclerosis, an autoimmune disease in which the immune system mistakenly attacks the nerve fibers that connect the brain to the body. Kulkarni agreed that it was possible and ordered an MRI to look for evidence of this or other anomalies. Was it a tumor? Or a stroke? Other autoimmune diseases also had to be considered. It can also be the result of infection: it could be Lyme disease; the same is true of cat-scratch fever, an infection caused by the bacterium Bartonella henselae; even syphilis, which is often called the great imitator because of its ability to manifest itself in so many ways, could cause such harm.

He sent the patient to the lab for testing.

The blood test results came back quickly. It wasn’t Lyme, it wasn’t Bartonella, it wasn’t syphilis. None of the inflammatory markers indicative of autoimmune disease were elevated. MRI gave the answer. Kulkarni did not see bright white dots and dashes that could indicate multiple sclerosis. Instead, the middle part of the left hemisphere of her brain was dominated by a large round object, a mass the size of a plum.

Kulkarni called the patient and told her that the MRI was not normal. She returned a couple of days later. He couldn’t tell her from the photographs what kind of tumor she had. The most common would be a meningioma, a tumor of the tissue that lines the brain. Acoustic neuroma was rarer but also possible. It is a slowly growing tumor that occurs in the tissue that connects the ear to the brain. She was young for this; these tumors usually appear in men and women over the age of 40 and usually cause hearing and balance problems rather than vision problems. Be that as it may, the tumor was so large that it blocked the circulation of cerebrospinal fluid through the brain, causing swelling of the nerve. It would have to be removed.

Kulkarni knew the patient had no health insurance. He called neurosurgeons he knew, trying to figure out how to get this woman the help she needed. Her only recourse was to go to the emergency room. Through a law called the Emergency Medical Care and Labor Act, all emergency departments are required to provide stabilizing treatment to any admitted patient, regardless of insurance status or ability to pay. The assistance provided is not free; patients are billed, but they need to be treated.

She went to the emergency room at New York-Presbyterian Hospital/Columbia University Medical Center

Where the tumor was removed. The pathologist confirmed that the tumor was an acoustic neuroma. While reading about this type of growth, the patient noted that hearing loss is a common symptom. After the operation, the hearing did not change, but the strange flashes of the stars completely disappeared. However, straight lines still tend to curve in her peripheral vision.

Even before her hair had grown long enough to hide the scar, bills began to come into her.

The numbers were even more frightening than the images of the tumor. The final accounting came to about $650,000. She and her husband feared that they would have to declare themselves bankrupt. They had money – they saved up for a rainy day, and then a tsunami. Salvation came unexpectedly when he asked each other if they had spoken to the hospital about financial assistance. It turned out that the Columbian Presbyterian did indeed have a financial aid program. Virtually all non-profit hospitals are required to provide financial assistance to people who need it; this is provided for by the Affordable Care Act. They didn’t have to go bankrupt. They are grateful that the test ended well. And two years after the operation, they begin to restore their savings – you never know when it will rain again.

 

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