When a 31-year-old woman with 20/20 vision suddenly started seeing "glistening star bursts" that made it impossible to see, her doctors investigated a variety of potential causes—until one doctor found "a mass about the size of a plum" in her brain scans, Lisa Sanders writes for the New York Times Magazine. 

Expedite patient diagnosis

'Glistening star bursts appeared weekly, then daily'

On a trip to Italy, the patient—a professional violinist and teacher—noticed "a shimmering shape with jagged, irregular edges" clouding her vision, Sanders writes.

According to the patient, the points of the shape seemed as if they were twinkling as the starlike image continued to grow, while the inside of the glittering shape looked like the crystals in a kaleidoscope. Then, the shape grew so large that it obstructed her vision almost entirely. Thirty minutes later, the shape slowly started to fade, and the world resumed its familiar look and shape.

Before this, the woman had similar, but less severe, experiences. "Every now and then, when she would get up quickly after sitting or lying down, she would feel an intense pressure inside her head, and when it released, everything briefly looked faded and pale before returning to normal hues," Sanders writes.

However, these strange spells only lasted for a few seconds and happened just a few times throughout the past few years. She simply attributed her symptoms to fatigue or stress. But after that day in Italy, the "glistening star bursts appeared weekly, then daily," Sanders adds.

In addition, the patient noticed that straight lines became distorted when she looked at them out of the corner of her eye. Objects such as doorways, curbs, and table edges also seemed distorted with bulges and divots unless she looked directly at them.

Investigating multiple causes

After a morning where a white fog overlaid her usual vision and nothing would help, the woman went to see Paul Shahinian, a physician in Fort Lee, N.J. "If the star bursts were worrisome to the young woman, Shahinian's reaction to her exam was terrifying," Sanders writes.

Shahinian explained that the optic nerve in her left eye was very inflamed, and that she needed to see a neuro-ophthalmologist, a specialist in eyes and brains, as quickly as possible. Although the woman still had 20/20 vision, the recurring star bursts and the bent lines in her peripheral vision signaled that something was wrong with the way her brain was receiving and processing visual information. 

With Shahinian's help, the woman made an appointment with Kaushal Kulkarni, a neuro-opthalmologist who was new to the area and could see her the soonest, for the following week. During that appointment, Kulkarni shined a narrow, bright light into the woman's right eye, causing both pupils to constrict—but when he shined the light in her left eye, both pupils immediately dilated.

"Clearly the signal on the left wasn't getting through," Sanders writes. "The swelling was cutting off the flow of information from the eye to the brain."

However, this was seemingly a one-way problem, since the left pupil constricted when the light was shined in the right eye—suggesting that information from the brainwas still getting through.

Notably, there are several potential causes of this type of optic-nerve injury, and her doctors weren't sure if her symptoms were the result of multiple sclerosis, a tumor, a stroke, another autoimmune disease, or an infection such Lyme disease or cat-scratch fever. They even noted that syphilis could cause this kind of optic-nerve injury.

Ultimately, an MRI ordered by Kulkarni identified the source of her vision problems: a mass "about the size of a plum," which "dominated the middle portion of the left side of her brain," Sanders writes.

To remove the tumor, the patient went to the ED at NewYork-Presbyterian Hospital/Columbia University Medical Center. After the tumor was removed, the pathologist confirmed that it was an acoustic neuroma.

'The price of doing what she loved'

After her surgery, the patient started researching acoustic neuromas. She discovered that hearing loss is a common symptom. Even though she had experienced hearing loss in her left ear, she hadn't made a connection between her hearing loss and her eye. 

The woman thought that the constant exposure to the sound of her violin could have caused some damage. "She figured it was just the price of doing what she loved," Sanders writes.

Although her hearing didn't change after the surgery, the strange star bursts disappeared completely. (Sanders, New York Times Magazine, 3/17)