Dr. Vaibhev Mittal
Ophthalmology (Eye Care)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
This question is in regards to my 12 year old daughter. She had a routine eye exam at the optometrist's who noticed that she had blurred disc margins. We were given a referral to an eye specialist, who checked her eyes and said that her vision and peripherals were perfect, but yes, there is a slight bulge behind her discs bilaterally. She assumed it was probably just a calcium deposit, but it was best to get an MRI to be sure. We have done the MRI and now are waiting to see the specialist again. But of course, we are panicking and thinking of worst case scenarios. I have viewed the MRI and can see a very small white dot on two different angles of the scan (see attached images). Does this look like something? Would love to get some feedback as soon as possible as we cannot handle waiting anymore. My daughter is asymptomatic at the moment. There is no loss of sight, no headaches, or dizziness. She seems fine. But we would like to be sure. Thank you.
Hello,
Welcome to icliniq.com.
Please do not worry.
A calcium deposit on the optic nerve head is known as an optic disc drusen which are easily seen on a B-scan or CT scan. That small area is in the white matter, and it is not related to optic disc swelling. This could be some incidental finding. Having said that, ask her doctor to check her pupillary reflexes, color vision, and do a field test. I hope this will help you. Regards.
Patient's Query
Hello doctor,
Thank you very much for the fast reply. It is much appreciated. I forgot to add but yes, she has had those tests too. Pupillary reflexes, field test, and color vision were all good. We are just more concerned about that small dot. Especially, if it could be an early sign of MS. Does it look like that to you?
Hello,
Welcome back to icliniq.com.
In acute stages, an MRI alone is not enough. An MRI with contrast would be is better. Moreover, a single lesion is insignificant. There must be at least one lesion in the different parts of the brain to diagnose it as MS. I hope this will help you. Regards.
Patient's Query
Hello doctor,
Thank you again. I have one last question, just want to clarify. Do you mean there has to be at least more than one lesion for it to qualify as MS? So, hopefully, just one lesion is not bad?
Hello,
Welcome back to icliniq.com.
Well, this topic needs an extensive discussion. I will try to share this complicated topic in a simple language. The diagnosis needs a dissemination of the lesions in space and time. The dissemination in space means the presence of one or more than one lesion in at least two areas out of the four areas (juxtacortical, infratentorial, periventricular and spinal cord), and that too in the T2 scan of the MRI. The dissemination in time means there must be at least two lesions, one old and one new. As there is only one lesion, it does not qualify for MS. You can get an MRI scan of the optic nerve. But go for a B-scan of the optic nerve head first. I hope this will help you. Regards.
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Ophthalmology (Eye Care)
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