What can cause an abnormal VEP?

[Mas1990]

Hello!
-24 year old female

So so far on my diagnostic journey I have:

-left sided hypereflexia, babinskis, clonus
-papilledema in right eye
-normal B12, negative Lyme, positive ANA (but negative antiDNA)

brain and c&t spine MRIs came back clear by radiologist (but there were things such as mild cervical spondylosis, multiple hemangiomas near T4, mild disc bulge here and there- that I assume could be causing my symptoms)

so, I assumed MS was off the table, because of the clean MRIs and spinal issues that could be causing things. However, yesterday I got a call from my neurologists nurse saying that my VEP came back mildly abnormal in my left eye and he would discuss it further with me at my follow up on the 14th. When I asked if he'd like me to do any other tests, she said no, he has everything he needs.

How important is this VEP test? What things could cause a mildly abnormal result in one eye? Any thoughts would be appreciated!

[jreagan70]

There are several things that can cause an abnormal VEP, so the results have to be put in context with other findings.

What I think is so interesting is that you have papilledema in your right eye -- which is clearly abnormal and not at all good -- and the attention seems to be going to a mildly abnormal VEP result for your left eye.

More logically, the eye with papilledema should be the one to have an abnormal VEP result. With the papilledema and conflicting information, I'm a little surprised that your neurologist hasn't referred you to a neuro-ophthalmologist for evaluation. My neuro-ophthalmologist likes to see papilledema cases fairly soon after referral, so it's curious that your neurologist is just sitting on yours. What's up with that?

[Mas1990]

Jreagan- thank you for your response! I agree! It is weird. I'm pretty sure it is the right eye he noticed the papilledema in, because that's the eye he spent a lot of time in with that light and seemed to be comparing it to the left. And then when telling me what he thought at the end of my exam and going over my symptoms said he felt we were probably looking at MS but there were lots of other tests to be done and other things to rule out. (lupus, S'jorgens, B-12 deficiency, etc.)

but then, it was his nurse who called, and unless she made a mistake, she told me it was the left eye that was abnormal. I guess I'll have to wait and see at my appointment next week! :/

so, do you know if a mildly abnormal VEP can be nothing to worry about/ just an issue with your eye maybe? Or is it always a sign of some disease/demyelination of some kind?

[Mas1990]

Thanks!

Jreagan- thank you for your response! I know! I thought it was weird, too! Unless the nurse made a mistake and told me it was the left eye, when she meant the right.

So, do you know if mildly abnormal VEP in one eye can ever be just normal? Or is it always caused by an underlying issue/demyelination?

[jreagan70]

Hi Mas:

It depends on how "mildly abnormal" the "mildly abnormal" is and what the other eye looks like. I've heard of instances where a neurologist called "abnormal" what an ophthalmologist would call in the normal range.

"Mildly abnormal" is too vague to base anything on. It really depends on what the actual numbers are and how they fit in with other test results. That's where a neuro-ophthalmologist could come in really handy.

It's also a good idea to start collecting copies of your medical records, including your MRI discs, radiology reports, lab results, VEP results and any other tests. Those could come in really handy later, too.

I hope you find out what you need to know at your appointment on the 14th.