Visual Disturbances and Leg Weakness: A Neurological Perspective

Visual abnormalities and weakness or numbness in the calves?

Hello Doctor, since June, I have been experiencing unclear vision on the edges of my left eye.
After an ophthalmological examination, a visual field defect was found, raising concerns about a possible neurological issue.
Additionally, for the past few months, I have been experiencing numbness and weakness below my right knee, which makes walking feel strange.
I have been continuously seeing both ophthalmology and neurology specialists.
Recently, I underwent carotid ultrasound and transcranial Doppler ultrasound examinations, as well as carotid sonography.
I also have a brain CT scan scheduled, but I need to wait a while for that.
Could you please help me review the other report values to see if they are normal? Should I return for a follow-up before the CT scan? Thank you.
B-Mode Findings: Normal at both carotid systems.

Doppler Findings: No hemodynamic change at both carotid systems.
Normal flow at both extracranial vertebral arteries.
The CCCD/TCD study is normal.

Comments: Suspect hypoplasia of the right vertebral artery.

TCD Interpretation: Normal temporal window on both sides.
Forward ophthalmic flow on both sides.
Increased velocity at both middle cerebral arteries.
Normal flow velocity and waveform in the other insonated arteries.

TCD Diagnosis: This is a normal TCD study, except possible stenosis at both middle cerebral arteries by velocity criteria (Right MCA mean velocity 123 cm/s, Left MCA mean velocity 120 cm/s).

Sonographic Data:
Carotid Sonographic Data:
B-Mode Doppler Remarks
Right Carotid:
- CCA Mid: Diameter 87 mm, PSV 50.00 cm/s, EDV 1.2 cm/s, TAV 0.69, PI 489
- ECA: Diameter 115 mm, PSV 51 cm/s, EDV 1.8 cm/s, PI 0.8, RI 150
- ICA: Diameter 89 mm, PSV 62.8 cm/s, EDV 0.56 cm/s, TAV 321
- SCA: Diameter 139 mm, PSV 34 cm/s, EDV 4.8 cm/s, PI 1.00
- VA: Diameter 55 mm, PSV 31 cm/s, EDV 1.2 cm/s, PI 0.67
- OA: Diameter 22 mm, PSV 10.6 cm/s, EDV 1.6 cm/s, PI 0.77727
- Forward IMT: 0.68 mm
B-Mode Doppler Remarks
Left Carotid:
- CCA Mid: Diameter 91 mm, PSV 53 cm/s, EDV 1.1 cm/s, PI 0.66, RI 457

A Bo, 40~49 year old female. Ask Date: 2022/12/20

Dr. Jiang Junyi reply Neurology

Dear Miss Abo,
You mentioned that "the edges of things appear unclear in my left eye." The report seems unable to explain this condition, but it does mention "suspect hypoplasia of the right vertebral artery." I wonder if you have any risk factors for cerebrovascular disease? The risk factors include diabetes, hypertension, smoking, and hyperlipidemia.
Prolonged exposure to these risk factors can lead to atherosclerosis, increasing the likelihood of cerebrovascular and cardiovascular diseases.
You also mentioned that "the CT scan will take a while longer to be done." If your condition progresses rapidly, I recommend going to the emergency room to arrange for urgent brain imaging.
If your symptoms persist without improvement, I suggest returning to your neurologist sooner to discuss further evaluation and treatment.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2022/12/20

More Info

Understanding visual disturbances and leg weakness can be quite complex, especially when neurological issues are suspected. Based on your symptoms and the findings from your recent tests, it appears that you are experiencing a combination of visual deficits and lower limb weakness, which may indeed indicate an underlying neurological condition.

Firstly, the visual disturbances you describe, particularly the unclear vision in your left eye and the presence of visual field defects, could be indicative of a problem with the optic nerve or other parts of the visual pathway in the brain. Given that you have already undergone a series of tests, including carotid ultrasound and transcranial Doppler (TCD) studies, it is essential to interpret these results in the context of your symptoms.

The B-Mode findings from your carotid ultrasound indicate that there is some degree of stenosis (narrowing) in both the right and left common carotid arteries (CCA) and internal carotid arteries (ICA). Specifically, the right ICA shows a 62% stenosis, while the left ICA shows a 53% stenosis. These findings suggest that there may be reduced blood flow to the brain, which could potentially contribute to neurological symptoms, including visual disturbances and leg weakness. The Doppler findings indicate normal flow in the vertebral arteries (VA), which is a positive sign, but the mention of possible stenosis in the middle cerebral arteries (MCA) by velocity criteria is concerning. The increased velocity in the MCAs could suggest that there is a significant hemodynamic change, which might affect cerebral perfusion.

Your symptoms of right leg weakness and a "funny" feeling when walking could be attributed to several factors, including reduced blood flow to the brain due to carotid artery stenosis or other neurological issues. The fact that you are experiencing these symptoms on the right side may suggest that there is a lesion or dysfunction in the left hemisphere of your brain, as motor control is typically contralateral.

Regarding the need for a CT scan, it is crucial to follow up with your healthcare provider as soon as possible, especially given your ongoing symptoms and the findings from your previous tests. A CT scan can help identify any structural abnormalities in the brain, such as lesions, strokes, or other conditions that could be contributing to your symptoms. If you notice any worsening of your symptoms, such as increased weakness, changes in vision, or new neurological signs, you should seek immediate medical attention.

In summary, your symptoms of visual disturbances and leg weakness warrant further investigation, particularly with the upcoming CT scan. The findings from your carotid ultrasound and TCD studies suggest that there may be vascular issues contributing to your neurological symptoms. It is essential to maintain close communication with your healthcare providers, adhere to their recommendations, and report any changes in your condition promptly. Early intervention can be critical in managing neurological conditions effectively.

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