Medical question

Diakaryu · 2nd February 2009, 03:13 PM

I know these questions are best referred to a qualified doctor/specialist and we are pursuing that route as I write this. But, I wanted to see if I could tap you folks to get pointed in the right direction.

My father, recently begun experiencing all of the symptoms of a detached retina. For ease here's a decent link to it's description.

http://www.medicinenet.com/retinal_d...nt/article.htm

However after going to the doctor they informed him that it was instead neurological. We've been trying to figure what kind of Neuro problem it could be but so far our efforts haven't come up with much.

Now, I fully understand that amateur diagnosis is foolish so I've no plans too present any advice to my father. I'll leave that in the hands of people with lots of letters before and after there name. I'm just hoping somebody here might have had something similar happen to them and what caused it.

Thanks in advance
D.

ElMondoHummus · 2nd February 2009, 03:27 PM

Happened to my late father a long time ago; required laser reattachment surgery that day (the day it was diagnosed).

What kind of doctor did the examination? If it's an internist or general practitioner, he must have reason for suspecting what he (or she) does, but on the other hand, you'd think that your dad would get a referral to an ophthalmologist. Anyway, was it one of those who made the diagnosis?

Diakaryu · 2nd February 2009, 03:49 PM

Some Ophthalmologist at the Berkeley Eye Center in Houston, Tx. He was told and did the test for detached retina. No dice which is why they doctor indicated it was in his brain.

D.

T.A.M. · 2nd February 2009, 04:41 PM

IF your father was simply suffering from floaters, scotomas, etc..., there are a number of conditions that can present this way. Migraines (most common), PVD, optic neuritis (less common), tumors, MS, you name it.

If he experiencing part of his vision actually gone (curtain sign), then the diagnosis of Retinal Detachment is much more likely, but not absolute.

If a trained ophthalmologist examined him, and did not detect a detachment, it is a pretty good bet he does not have it.

TAM

ElMondoHummus · 2nd February 2009, 04:50 PM

Well, an opthal would be trained and would also discuss with colleagues if there were any doubt. So while it still would be good to ask "What tells you this is not a detachment?" (that's more in the vein of "Trust but Verify", not "Hey Doc, I need convincing"), I'd consider what the doc says to be a solid diagnosis.

I'm now out of my depth at this point. Again, my own late dad's problem was indeed a retinal detachment, so my experience diverges from yours at the point of diagnosis. My guess is that you're going to get a referral to whatever specialist the opthal thinks he should go to, probably some neurologist or neurosurgeon. Some of the actual doctors in this forum - T.A.M., for example, is a physician located in Canada - might be able to get more specific than this, but that's what I would predict would happen next.

If you're confident in your doctor's abilities - for example, if he's both Board Certified and has seen many cases of retinal detachment - I'd say he's trustworthy. Now, the next question is, what other conditions might lead to similar symptoms. And that I don't know. I wonder if anyone else has run into this problem (which I can tell is the question you're asking in the OP: Has anyone else experienced or heard of a case where the symptoms track for retinal detachment, but the exam shows that such may not have happened? That's a good question for the rest of the forum here).

ETA: Ah. T.A.M. found this and posted while I was composing.

Dancing David · 3rd February 2009, 09:08 AM

Originally Posted by Diakaryu

Some Ophthalmologist at the Berkeley Eye Center in Houston, Tx. He was told and did the test for detached retina. No dice which is why they doctor indicated it was in his brain.

D.

It could be many things that cause a blurring of vision in a specific part of the visual field.

Nerve damage, pressure on the nerves, mini-stokes and other problems in the brain and nerves.

fuelair · 3rd February 2009, 09:40 AM

Originally Posted by T.A.M.

IF your father was simply suffering from floaters, scotomas, etc..., there are a number of conditions that can present this way. Migraines (most common), PVD, optic neuritis (less common), tumors, MS, you name it.

If he experiencing part of his vision actually gone (curtain sign), then the diagnosis of Retinal Detachment is much more likely, but not absolute.

If a trained ophthalmologist examined him, and did not detect a detachment, it is a pretty good bet he does not have it.

TAM

And, if there was and he missed it and... you may want to be consulting with an attorney. Hope though that is not the case!!

T.A.M. · 3rd February 2009, 02:18 PM

Yah, nothing is 100%, but retinal detachment is so common (as serious eye problems go), that the ophth's are pretty good at diagnosing it or ruling it out. I suspect a CT, and probably (give it is the USA) an MRI are in the plans soon, or SHOULD be, and likely a neurosurgical or neurology referral.

TAM

T.A.M. · 3rd February 2009, 02:19 PM

Originally Posted by fuelair

And, if there was and he missed it and... you may want to be consulting with an attorney. Hope though that is not the case!!

indeed.

TAM

Ivor the Engineer · 3rd February 2009, 03:00 PM

Originally Posted by fuelair

And, if there was and he missed it and... you may want to be consulting with an attorney. Hope though that is not the case!!

Can attorney's perform retinal detachment surgery?

ElMondoHummus · 3rd February 2009, 03:19 PM

Originally Posted by T.A.M.

I suspect a CT, and probably (give it is the USA) an MRI are in the plans soon, or SHOULD be...

What? You Canucks haven't invented magnetic resonance imaging yet

? I'm sure we got a few down here we can sell ya.

ElMondoHummus · 3rd February 2009, 03:23 PM

Originally Posted by Ivor the Engineer

Can attorney's perform retinal detachment surgery?

Anyone can. Just take a bat to the back of the head, and WHAM! Instant retinal detachment.

The question is, can one perform retinal reattachment surgery? I'd think that is what you'd rather have done in the case of a misdiagnosis.

T.A.M. · 3rd February 2009, 06:18 PM

Originally Posted by ElMondoHummus

What? You Canucks haven't invented magnetic resonance imaging yet

? I'm sure we got a few down here we can sell ya.

Yah we have them, we get about 1-2 machines per province in the atlantic region, and I guess a few more in "Upper" Canada.

Usually takes a note from God to get an MR Image done though. So unless it was NEEDED as opposed to DESIRED, it would not likely get done.

TAM

SYLVESTER1592 · 3rd February 2009, 06:43 PM

T.A.M. already said it.

It's hard to say what the problem is yet, if it's not in his eye.
There are a lot of other questions the neurologist might have...

Do you know which part of his visual field he lost, if any? both eyes, or a single?
Can he draw the abarations in his visual field?
Is it always in the same place?
What color does it have?
Can he identify the things he sees in the room?
Does he use anticoagulants?
Did he have any of these symptoms before?
How long do the symptoms last?
What other symptoms does he have?

Maybe some things to think about when he goes to see a neurologist.
Hope everything is well.

SYL

Walrus32 · 4th February 2009, 01:39 PM

Failing vision in an elderly individual because of a neurologic cause would to me suggest macular degeneration.

T.A.M. · 4th February 2009, 03:53 PM

Originally Posted by Walrus32

Failing vision in an elderly individual because of a neurologic cause would to me suggest macular degeneration.

Yes, however, the same Ophthamologist who eliminated Retinal Detachment, if he is worth his salt, would have even more easily refuted or confirmed the presence of Macular Degeneration.

TAM

Walrus32 · 7th February 2009, 07:27 AM

That's a given. I was speaking in general terms.

Dr. Imago · 7th February 2009, 08:32 AM

Originally Posted by Walrus32

Failing vision in an elderly individual because of a neurologic cause would to me suggest macular degeneration.

Macular degeneration is a chronic, insidious condition. Retinal detachment is an acute, sudden loss of vision. The two have very different presentations.

Amaurosis fugax could be the presenting complaint here, in which case it is a medical emergency. It can be paroxysmal in nature, and a definitive etiology must be determined. Also, there could be other factors at play within the brain's parenchyma (transient ischemic attack, brain mass effect, simple partial seizures, etc.).

Do not blow this off. If it's not a retinal detachment, then additional work-up is needed relatively urgently (ESR, perhaps brain MRI, etc.). Never mess with visual disturbances until you know exactly what is going wrong. The end result could be permanent blindness, a devastating outcome.

~Dr. Imago

T.A.M. · 7th February 2009, 11:58 AM

Originally Posted by Dr. Imago

Macular degeneration is a chronic, insidious condition. Retinal detachment is an acute, sudden loss of vision. The two have very different presentations.

Amaurosis fugax could be the presenting complaint here, in which case it is a medical emergency. It can be paroxysmal in nature, and a definitive etiology must be determined. Also, there could be other factors at play within the brain's parenchyma (transient ischemic attack, brain mass effect, simple partial seizures, etc.).

Do not blow this off. If it's not a retinal detachment, then additional work-up is needed relatively urgently (ESR, perhaps brain MRI, etc.). Never mess with visual disturbances until you know exactly what is going wrong. The end result could be permanent blindness, a devastating outcome.

~Dr. Imago

Agreed. However, common things being common, I would not press any panic buttons either. A CT Scan +/- MRI at Neurology's discretion is how I would approach this one.

TAM

2nd February 2009, 03:13 PM	#1
Diakaryu New Blood Join Date: Jun 2006 Posts: 24	Medical question I know these questions are best referred to a qualified doctor/specialist and we are pursuing that route as I write this. But, I wanted to see if I could tap you folks to get pointed in the right direction. My father, recently begun experiencing all of the symptoms of a detached retina. For ease here's a decent link to it's description. http://www.medicinenet.com/retinal_d...nt/article.htm However after going to the doctor they informed him that it was instead neurological. We've been trying to figure what kind of Neuro problem it could be but so far our efforts haven't come up with much. Now, I fully understand that amateur diagnosis is foolish so I've no plans too present any advice to my father. I'll leave that in the hands of people with lots of letters before and after there name. I'm just hoping somebody here might have had something similar happen to them and what caused it. Thanks in advance D.
Diakaryu New Blood Join Date: Jun 2006 Posts: 24

2nd February 2009, 03:27 PM	#2
ElMondoHummus 0.25 short of being half-witted Join Date: Oct 2006 Location: Somewhere north of the South Pole Posts: 11,945	Happened to my late father a long time ago; required laser reattachment surgery that day (the day it was diagnosed). What kind of doctor did the examination? If it's an internist or general practitioner, he must have reason for suspecting what he (or she) does, but on the other hand, you'd think that your dad would get a referral to an ophthalmologist. Anyway, was it one of those who made the diagnosis?
	__________________ must take this very carefully....booze is wise men's drink..... -pillory "... I'm quite willing to have everyone use my rejection of the 9/11 conspiracy theory as a basis for assessing my intelligence, judgment, and trustworthiness" -Prof. Ann Althouse

2nd February 2009, 03:49 PM	#3
Diakaryu New Blood Join Date: Jun 2006 Posts: 24	re Some Ophthalmologist at the Berkeley Eye Center in Houston, Tx. He was told and did the test for detached retina. No dice which is why they doctor indicated it was in his brain. D.
Diakaryu New Blood Join Date: Jun 2006 Posts: 24

2nd February 2009, 04:50 PM	#5
ElMondoHummus 0.25 short of being half-witted Join Date: Oct 2006 Location: Somewhere north of the South Pole Posts: 11,945	Well, an opthal would be trained and would also discuss with colleagues if there were any doubt. So while it still would be good to ask "What tells you this is not a detachment?" (that's more in the vein of "Trust but Verify", not "Hey Doc, I need convincing"), I'd consider what the doc says to be a solid diagnosis. I'm now out of my depth at this point. Again, my own late dad's problem was indeed a retinal detachment, so my experience diverges from yours at the point of diagnosis. My guess is that you're going to get a referral to whatever specialist the opthal thinks he should go to, probably some neurologist or neurosurgeon. Some of the actual doctors in this forum - T.A.M., for example, is a physician located in Canada - might be able to get more specific than this, but that's what I would predict would happen next. If you're confident in your doctor's abilities - for example, if he's both Board Certified and has seen many cases of retinal detachment - I'd say he's trustworthy. Now, the next question is, what other conditions might lead to similar symptoms. And that I don't know. I wonder if anyone else has run into this problem (which I can tell is the question you're asking in the OP: Has anyone else experienced or heard of a case where the symptoms track for retinal detachment, but the exam shows that such may not have happened? That's a good question for the rest of the forum here). ETA: Ah. T.A.M. found this and posted while I was composing.
	__________________ must take this very carefully....booze is wise men's drink..... -pillory "... I'm quite willing to have everyone use my rejection of the 9/11 conspiracy theory as a basis for assessing my intelligence, judgment, and trustworthiness" -Prof. Ann Althouse

3rd February 2009, 09:08 AM	#6
Dancing David Penultimate Amazing Join Date: Mar 2003 Location: Central Illinois Posts: 34,729	Originally Posted by Diakaryu Some Ophthalmologist at the Berkeley Eye Center in Houston, Tx. He was told and did the test for detached retina. No dice which is why they doctor indicated it was in his brain. D. It could be many things that cause a blurring of vision in a specific part of the visual field. Nerve damage, pressure on the nerves, mini-stokes and other problems in the brain and nerves.
	__________________ Hell, dynamiting fish in a barrel is more challenging. - Ladewig I suspect you are a sandwich, metaphorically speaking. -Donn And a shot rang out. Now Space is doing time... -Ben Burch You built the toilet - don't complain when people crap in it. _Kid Eager

2nd February 2009, 04:41 PM	#4
T.A.M. Keeper of the Kool-Vax Join Date: Jul 2006 Location: The Far East...of Canada Posts: 20,816	IF your father was simply suffering from floaters, scotomas, etc..., there are a number of conditions that can present this way. Migraines (most common), PVD, optic neuritis (less common), tumors, MS, you name it. If he experiencing part of his vision actually gone (curtain sign), then the diagnosis of Retinal Detachment is much more likely, but not absolute. If a trained ophthalmologist examined him, and did not detect a detachment, it is a pretty good bet he does not have it. TAM

3rd February 2009, 09:40 AM	#7
fuelair Cythraul Enfys Join Date: May 2006 Posts: 28,961	Originally Posted by T.A.M. IF your father was simply suffering from floaters, scotomas, etc..., there are a number of conditions that can present this way. Migraines (most common), PVD, optic neuritis (less common), tumors, MS, you name it. If he experiencing part of his vision actually gone (curtain sign), then the diagnosis of Retinal Detachment is much more likely, but not absolute. If a trained ophthalmologist examined him, and did not detect a detachment, it is a pretty good bet he does not have it. TAM And, if there was and he missed it and... you may want to be consulting with an attorney. Hope though that is not the case!!
fuelair Cythraul Enfys Join Date: May 2006 Posts: 28,961	__________________ There is no problem so great that it cannot be fixed by small explosives carefully placed. Wash this space! We fight for the Lady Babylon!!!

3rd February 2009, 02:18 PM	#8
T.A.M. Keeper of the Kool-Vax Join Date: Jul 2006 Location: The Far East...of Canada Posts: 20,816	Yah, nothing is 100%, but retinal detachment is so common (as serious eye problems go), that the ophth's are pretty good at diagnosing it or ruling it out. I suspect a CT, and probably (give it is the USA) an MRI are in the plans soon, or SHOULD be, and likely a neurosurgical or neurology referral. TAM

3rd February 2009, 02:19 PM	#9
T.A.M. Keeper of the Kool-Vax Join Date: Jul 2006 Location: The Far East...of Canada Posts: 20,816	Originally Posted by fuelair And, if there was and he missed it and... you may want to be consulting with an attorney. Hope though that is not the case!! indeed. TAM

3rd February 2009, 03:00 PM	#10
Ivor the Engineer Philosopher Join Date: Feb 2006 Location: South Britain, near the middle Posts: 9,553	Originally Posted by fuelair And, if there was and he missed it and... you may want to be consulting with an attorney. Hope though that is not the case!! Can attorney's perform retinal detachment surgery?
	__________________ My Blog.

3rd February 2009, 03:19 PM	#11
ElMondoHummus 0.25 short of being half-witted Join Date: Oct 2006 Location: Somewhere north of the South Pole Posts: 11,945	Originally Posted by T.A.M. I suspect a CT, and probably (give it is the USA) an MRI are in the plans soon, or SHOULD be... What? You Canucks haven't invented magnetic resonance imaging yet ? I'm sure we got a few down here we can sell ya.
	__________________ must take this very carefully....booze is wise men's drink..... -pillory "... I'm quite willing to have everyone use my rejection of the 9/11 conspiracy theory as a basis for assessing my intelligence, judgment, and trustworthiness" -Prof. Ann Althouse

3rd February 2009, 03:23 PM	#12
ElMondoHummus 0.25 short of being half-witted Join Date: Oct 2006 Location: Somewhere north of the South Pole Posts: 11,945	Originally Posted by Ivor the Engineer Can attorney's perform retinal detachment surgery? Anyone can. Just take a bat to the back of the head, and WHAM! Instant retinal detachment. The question is, can one perform retinal *reattachment* surgery? I'd think that is what you'd rather have done in the case of a misdiagnosis.
	__________________ must take this very carefully....booze is wise men's drink..... -pillory "... I'm quite willing to have everyone use my rejection of the 9/11 conspiracy theory as a basis for assessing my intelligence, judgment, and trustworthiness" -Prof. Ann Althouse

3rd February 2009, 06:18 PM	#13
T.A.M. Keeper of the Kool-Vax Join Date: Jul 2006 Location: The Far East...of Canada Posts: 20,816	Originally Posted by ElMondoHummus What? You Canucks haven't invented magnetic resonance imaging yet ? I'm sure we got a few down here we can sell ya. Yah we have them, we get about 1-2 machines per province in the atlantic region, and I guess a few more in "Upper" Canada. Usually takes a note from God to get an MR Image done though. So unless it was NEEDED as opposed to DESIRED, it would not likely get done. TAM

3rd February 2009, 06:43 PM	#14
SYLVESTER1592 Critical Thinker Join Date: May 2007 Location: feeding the fish Posts: 307	T.A.M. already said it. It's hard to say what the problem is yet, if it's not in his eye. There are a lot of other questions the neurologist might have... Do you know which part of his visual field he lost, if any? both eyes, or a single? Can he draw the abarations in his visual field? Is it always in the same place? What color does it have? Can he identify the things he sees in the room? Does he use anticoagulants? Did he have any of these symptoms before? How long do the symptoms last? What other symptoms does he have? Maybe some things to think about when he goes to see a neurologist. Hope everything is well. SYL
	__________________ -"Only by following the trail that civilization and the human spirit have gone along to reach a higher stage of development is it possible to know and understand one's fellow man".- E.C. Van Leersum, 1862-1938, prof. Medical History, University of Leiden, The Netherlands.

4th February 2009, 01:39 PM	#15
Walrus32 Critical Thinker Join Date: Aug 2007 Posts: 469	Failing vision in an elderly individual because of a neurologic cause would to me suggest macular degeneration.
Walrus32 Critical Thinker Join Date: Aug 2007 Posts: 469	__________________ Bibo, ergo sum.

4th February 2009, 03:53 PM	#16
T.A.M. Keeper of the Kool-Vax Join Date: Jul 2006 Location: The Far East...of Canada Posts: 20,816	Originally Posted by Walrus32 Failing vision in an elderly individual because of a neurologic cause would to me suggest macular degeneration. Yes, however, the same Ophthamologist who eliminated Retinal Detachment, if he is worth his salt, would have even more easily refuted or confirmed the presence of Macular Degeneration. TAM

7th February 2009, 07:27 AM	#17
Walrus32 Critical Thinker Join Date: Aug 2007 Posts: 469	That's a given. I was speaking in general terms.
Walrus32 Critical Thinker Join Date: Aug 2007 Posts: 469	__________________ Bibo, ergo sum.

7th February 2009, 08:32 AM	#18
Dr. Imago Master Poster Join Date: Aug 2001 Posts: 2,051	Originally Posted by Walrus32 Failing vision in an elderly individual because of a neurologic cause would to me suggest macular degeneration. Macular degeneration is a chronic, insidious condition. Retinal detachment is an acute, sudden loss of vision. The two have very different presentations. Amaurosis fugax could be the presenting complaint here, in which case it is a medical emergency. It can be paroxysmal in nature, and a definitive etiology must be determined. Also, there could be other factors at play within the brain's parenchyma (transient ischemic attack, brain mass effect, simple partial seizures, etc.). Do not blow this off. If it's not a retinal detachment, then additional work-up is needed relatively urgently (ESR, perhaps brain MRI, etc.). Never mess with visual disturbances until you know exactly what is going wrong. The end result could be permanent blindness, a devastating outcome. ~Dr. Imago
Dr. Imago Master Poster Join Date: Aug 2001 Posts: 2,051	__________________ DISCLAIMER: The above post is for informational and/or educational purposes only. It is not a substitute for the professional judgment of, in direct consultation with, a health care professional in diagnosing, treating, and/or preventing any disease or disorder. It is not to be construed as individualized medical advice, diagnosis, or a treatment recommendation. Your reliance upon the information obtained or used by you at, through, or as a result of this post is solely at your own risk.

7th February 2009, 11:58 AM	#19
T.A.M. Keeper of the Kool-Vax Join Date: Jul 2006 Location: The Far East...of Canada Posts: 20,816	Originally Posted by Dr. Imago Macular degeneration is a chronic, insidious condition. Retinal detachment is an acute, sudden loss of vision. The two have very different presentations. Amaurosis fugax could be the presenting complaint here, in which case it is a medical emergency. It can be paroxysmal in nature, and a definitive etiology must be determined. Also, there could be other factors at play within the brain's parenchyma (transient ischemic attack, brain mass effect, simple partial seizures, etc.). Do not blow this off. If it's not a retinal detachment, then additional work-up is needed relatively urgently (ESR, perhaps brain MRI, etc.). Never mess with visual disturbances until you know exactly what is going wrong. The end result could be permanent blindness, a devastating outcome. ~Dr. Imago Agreed. However, common things being common, I would not press any panic buttons either. A CT Scan +/- MRI at Neurology's discretion is how I would approach this one. TAM