How can I improve my vision with hemianopia and diabetes?

Hello,

I appreciate that you have chosen icliniq.com for your medical needs.

I am here to give you the best care possible.

I am so sorry to hear about what you are going through. I reviewed your uploaded documents (attachment removed to protect the patient’s identity). As you explained and according to your documents, your problem is left-sided hemianopia. This means that you cannot see objects on the left side of your visual field. It may seem confusing, but your problem is not in your eyes or optic nerve. Both of them work properly.

The problem is in the specific part of your brain at the back of your head that processes the data recorded by your eyes. We have two centers that process visual data in our brain: one for the right side of the visual field and one for the left side. In your case, the center for analyzing the left-side data has been injured by a blood clot. By definition, injuries of the brain due to a blood clot are called strokes.

Both diabetes and low ejection fraction heart failure are risk factors for stroke. Unfortunately, at present, there is no medication to resolve your visual field defect. However, it is very important to start treatment to prevent more strokes.

Without such treatment, not only is your remaining eyesight endangered, but a second stroke could also cause movement or speech disabilities. You should start stroke prevention treatment under the supervision of a neurologist.

Moreover, your heart should be checked by your cardiologist to determine if a specific drug to prevent clots is needed. Meanwhile, you should avoid driving to prevent accidents due to your visual defects.

Hope I have clarified your query. I will be happy to help you further.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

The clot should have dissolved by now because the body has a system that does this automatically. Unfortunately, brain cells are very sensitive to decreases in oxygen levels. If oxygen transport is disrupted for just four minutes, irreversible cell death (stroke) can occur.

Regarding your visual field defect, I need to see your brain imaging to give you a robust judgment about its course and potential improvement. It is important to know which Ecosprin product you are taking.

Is it a combination of Aspirin and Clopidogrel, or just Aspirin?

I hope this helps you.

Thank you for consulting me.

Hi,

Welcome back to icliniq.com.

I have reviewed the attached image (attachment removed to protect the patient’s identity). Your Ecosprin contains ASA or acetylsalicylic acid (a stroke prevention medication, 75 mg) and Atorvastatin (20 mg). I have also reviewed your brain MRI (magnetic resonance imaging). The image resolution is low, and I could only see two sequences of the MRI. The stroke lesion in the vision area of the right brain hemisphere is evident.

Fortunately, the size of the stroke is not large, but it has affected the majority of your visual cortex. Therefore, I regret to inform you that the chance of complete improvement of your visual field is very low. I understand that coping with a visual field defect is challenging, but I have a more pressing concern for you.

The location and shape of your brain lesion suggest that the underlying cause of the clot might be embolic, meaning it could have originated from a distant artery or your heart.

While diabetes is a risk factor for thrombosis, it is not typically associated with embolic events. However, your recently diagnosed heart failure increases the risk of embolic events. Considering your low ejection fraction of 20 percent, there is a high possibility that the source of your brain stroke was a clot formed in your heart due to low ejection and blood stasis. This is critical because such events can recur and potentially cause paralysis or affect your other right visual field.

If your heart is indeed the source of clot formation, Ecosprin alone may not adequately protect you from a second stroke. In such a case, you would require a different class of medication called an anticoagulant.

Here are my recommendations for you:

1. Request a review of your condition and medication by both your neurologist and cardiologist.
2. Undergo MRA (magnetic resonance angiography) to screen for any stenosis in your main brain arteries.
3. Repeat your echocardiography to check for clot formation or significant hypokinesia (reduced movement) in the heart wall.
4. If evaluations show no stenosis in your cervical arteries but reveal clot formation or severe wall hypokinesia in the heart, consider starting anticoagulants for secondary stroke prevention.
5. Consider adjusting the dose of Atorvastatin based on your blood lipid levels; typically, at least 40 mg daily is recommended in most cases.
6. Avoid driving a car, motorcycle, or bicycle due to the high risk of accidents or injuries to yourself, as well as to other drivers and pedestrians.

I hope this has helped you. Please feel free to reach out to me again in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

Has your cardiologist been informed about your recent stroke? If not, please inform and request an evaluation to determine if it occurred due to your heart failure. As I explained earlier, this information is crucial for selecting the best stroke prevention medication for you.

Regarding your question about MR angiography, yes, it is similar to your previous MRI, but before the image is captured, they will inject an MRI (magnetic resonance imaging) contrast into your vein. A similar image can be obtained with a CT (computed tomography) scan using a contrast injection, but given your diabetes, an MRI is safer for you.

Please note that the optimal LDL (low-density lipoproteins) level for someone with a history of stroke differs from that of others. It should be maintained below 1.8 mmol/L (less than 70 mg/dL).

I hope this helps you.

Thank you for consulting me.