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Dr.Shakeel Ansari
Dr.Shakeel Ansari, Neurology Specialist
Category: Neurology
Satisfied Customers: 254
Experience:  Post Graduate Diploma Clinical Neurology
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A brain clip has a swelling near the optic nerve. Optic

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A brain clip has a swelling near the optic nerve. Optic neuritis ruled out and steroids started and reduced. No change. Inflammation cause unknown. Dye through veins shows no blood flow so anuerusm secure. What research or plan can we expect for patient about to be discharged for what of anyone with specialist knowledge on how to treat this. Headaches and eye blur consistent last 5 mths
JA: The Doctor can help. Just a couple quick questions before I transfer you. What are your symptoms? Have you used any medication for this?
Customer: In hospital and MRI and CSA done. Dye vein brain scan done. Steroids not given before but since 18th April until now.
JA: Have you seen a doctor about this?
Customer: I need a specialist with specific knowledge on what gets done if clipping has this outcome year later. And issues long term with eyesight and potential for optic nerve problems /loss of sight.
JA: Anything else in your medical history you think the Doctor should know?
Customer: No. Aged 52 woman. Clipping carried out April 2020
JA: OK. I'm sending you to a secure page to join JustAnswer. While you're filling out that form, I'll tell the Expert about your situation and then connect you two.
JA:

This is Dr Ansari, welcome to JA,

May know the report of MRI, MRA orbit with contrast? Any carotid Artery angiogram done?It is essential to know that if an Aneurysm is clipped which artery is that and is it causing any compression to nearby nerves or not.

In the orbit both  ophthalmic artery and Internal carotid aneurysms are possible.

Customer: replied 12 days ago.
The aneurism is close to the optic nerve and the mass is adjacent to the clipping. Apologies I do not know specifics but am aware the Opthomologist has looked at whilst MRA contrast was done and all good I am told
Customer: replied 12 days ago.
She has had a CSA and CT too. For me I want to discern if the mass is likely to grow or if delays in aftercare are likely to have caused it? The sight blurring is a concern and some indication that if a biopsy was taken it may result in blindness. This is as a last resort and not being pursued as yet . Only steroids being reduced and being discharged as stable. But what is likely prognosis

CSA and CT please what it stands for?

Customer: replied 12 days ago.
MRi scam and CT for brain too

MRI and MRA brain and orbit with contrast, but please make sure this clip is paramagnetic before doing MRI.

Customer: replied 12 days ago.
Hi. I am not concerned about the actual MRI. It has been done. So have several CT and MRI. The clip is titanium and the MRI were sufficiently robust. I want to know about the appearance of a mass near the clipping. Apparently due to inflammation of/around the clipping and anuerusm has not been compromised. I want specialist advice on things that go wrong following a clipping and how and what is likely to happen to this mass and what can counter /resolve it conservatively and without biopsy which may cause sight loss due to proximity to optic nerve?

It depends on which artery is clipped and the aneurysm was ruptured or not. What type of mass is beside the clip.And where it is clipped in Orbit conal or extra conal area. You have to upload the MRI of the Orbit post and pre-Clipping

With missing or suppressed pieces of information, the answers can not be given to the questions you asked.

Dr Ansari

I can enumerate in general the complications due to the mass and due to any post clip complications. These complications may or may not happen to you depending on your specific situation.

  • Orbital cellulitis (bacterial, viral, fungal)
  • Cavernous sinus thrombosis
  • Carotid-cavernous fistula
  • Orbital inflammatory syndrome
  • Brainstem infarction
  • blindness with retinal and optic nerve damage
  • Anterior segment ischemia
  • Posterior segment ischemia
  • Elevated IOP
  • optic disc oedema
  • severe attenuation of arteries and veins
  • diffuse retinal opacification
  • irregular size and function of pupil
  • Pituitary gland infraction

Dr Ansari.

Customer: replied 12 days ago.
Thank you whilst you cannot be specific this allows me to push back on clinicians and ask questions for treatment and ongoing support for patient
Thank you.
And I cannot share the MRI scans apologies.
Also.
With care are any of these fatal? And what kind of treatment plan i.e. would steroids cover most or more.knvasive needed.

You are most welcome.

Customer: replied 12 days ago.
Apologies terrible typing. The list you supply is very helpful.
As yet clinicians are merely saying "they do not know" how to treat the inflammation and your list allows better shaped Q's and improved querying for treatment.
I don't know whether the inflammation treated on steroids will "shrink" or once they cease will grow? Or long term impact and is it life threatening/shortening?
They thought it was optic neuritis but now believe it isn't so it.must present similar. If that helps you better answer my questions on how to support this going forward? And what I ought to ask a clinician.
Thanks

The steroids will shrink the mass (SOL) and its mass effects will decrease also it may be more accessible to remove surgically. Once steroids are stopped the mass may grow depending on doubling  rate of the SOL.

It could be a Optic Neuroma.

Please do understand here in this chat we can say this may be is Optic nerve  Neuroma/ Glioma or vascular Angioma but can not say with 100% surity

If this is Optic Nerve Glioma the treatment options are Surgery and Radiotherapy. Surgery is always challenging and most not choose this option.

I wish if I can help you more, however, if you have any more query you are most welcome.I hope you are satisfied with the information I gave and has answer most of your queries.

Dr Ansari

Customer: replied 12 days ago.
I will ask which artery if I can

Ok, you are most welcome.

Dr Ansari

Customer: replied 10 days ago.
Hi. The Opthalmologist outcome:
Right eye: 6/60 Unaided, NIPH Pinhole
Left eye: 6/9 Unaided, NIPH Pinhole
Bitemporal Haemianopia
Bilateral optic disc pallor and cupping, right RAPD
Anuerism clip abutting chiasm- previous subarachnoid haemorrhage April 2020
Seen in Eye causality previous week and referred to beuro-opthalmology
Recent MRI - inflammation around aneaurysm clip abutting chains with oedema in the optic tracts and optic nerves
Ward referral? vasculitis
On exam, quiet segment
Bilateral optic disc cupping & temporal disc pallor
No signs of citrus/retinitis/vasculitis
Fundus fluorescein angiogram (FFA)- normal transit time, no signs of vasculitis or retinal ischaemia
fFa within normal limits- rveiwed by another who agrees.
Told to review with Beuro-opthalmology

OK, that explains clear that Aneurysm is clipped near optic chiasma and inflammation around the clipped aneurysm is affecting the optic tract and nerve. Certainly, you need Neuro-Ophthalmologist.

Dr Ansari

Potentially any artery around the chiasma can bear this aneurysm. In your update, it is not mentioned which artery has an aneurysm. I think it is better to follow up with Neuro-Ophthalmologist.

Dr Ansari

Customer: replied 9 days ago.
Thank you for your input and advice

You are most welcome.

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