Clinical care
Transient complete homonymous hemianopia associated with migraine

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Abstract

Introduction

Because of the transient and rare nature, objective visual and neuroimaging evaluation during an acute, spontaneous attack of a migrainous aura causing a complete homonymous hemianopia has not been reported.

Case Report

A healthy 27-year-old white woman with a history of typical aura with migraine presented during an episode of no light perception in the right hemifield of both eyes. Ophthalmic testing and neuroimaging were unremarkable. The visual field defect started to resolve 1 hour after initial symptoms, and significant improvement was seen after 4 hours. One year later, the patient had no visual field defects and had not experienced another episode of homonymous hemianopia.

Discussion

More than one third of migrainous patients experience visual symptoms. Typical aura with migraine is diagnosed usually by history. Laboratory testing and neuroimaging are necessary if an alternative cause is suspected, i.e., the aura begins after age 40 years, negative features are predominant, or the aura is very short or prolonged. Correct diagnosis is critical, because conditions that mimic migrainous aura have potentially devastating consequences. Migraine with aura patients may have persistent visual field defects and are at an increased risk for stroke compared with nonmigraine patients. This case improves our knowledge of the nature of a transient homonymous hemianopia associated with migraine.

Section snippets

Case report

A 27-year-old white woman reported to our clinic at 10:00 a.m. reporting that everything had gone dark on the right side of her vision one half hour previous. She reported running into walls, at which time a friend drove her to our clinic. She reported no tingling, numbness, or weakness of the extremities and no nausea, diplopia, oscillopsia, tinnitus, or headache. Her medical history was remarkable only for a history of migraines with an aura that occurred 2 to 4 times per week. The aura

Discussion

Migraine is a common cause of headache and is ranked number 19 among all worldwide diseases that cause disability.12 The Second Edition of The International Classification of Headache Disorders (ICHD-II)12 divides migraine into 2 major subtypes: migraine without aura and migraine with aura. Over one third of those with migraine experience visual symptoms,1, 2 and approximately 30% to 44% of those with migraine with aura also experience aura without headache.2, 13, 14, 15

The cause of migraine

Conclusion

This is the first report of objective visual testing and neuroimaging during an acute, spontaneous attack of a typical migrainous aura causing a complete homonymous hemianopia. Results of neuroimaging tests, including MRI and MRA, were unremarkable. The visual field defect began to resolve approximately 1 hour after onset. Four hours after onset, the visual field had improved significantly. One week after onset the visual defect was further resolved, and the patient has not had a recurrence of

References (85)

  • C. Cursiefen et al.

    Migraine and tension headache in high-pressure and normal-pressure glaucoma

    Am J Ophthalmol

    (2000)
  • Y. Liang et al.

    Migrainous infarction with appearance of laminar necrosis on MRI

    Clin Neurol Neurosurg

    (2007)
  • R.B. Lipton et al.

    Prevalence and burden of migraine in the United States: Data from the American Migraine Study II

    Headache

    (2001)
  • D.K. Ziegler et al.

    Specific headache phenomena: Their frequency and coincidence

    Headache

    (1990)
  • L.J. Launer et al.

    The prevalence and characteristics of migraine in a population-based cohort: The GEM study

    Neurology

    (1999)
  • L.P. Queiroz et al.

    Characteristics of migraine visual aura

    Headache

    (1997)
  • M. Wakakura et al.

    Permanent homonymous hemianopias following migraine

    J Clin Neuroophthalmol

    (1992)
  • M. Sullivan-Mee et al.

    Migraine-related visual-field loss with prolonged recovery

    J Am Optom Assoc

    (1997)
  • S. Resnick et al.

    Migraine with aura associated with reversible MRI abnormalities

    Neurology

    (2006)
  • L.S. Bowerman

    Transient visual field loss secondary to migraine

    J Am Optom Assoc

    (1989)
  • A.C. McNeal

    MRI during migraine with aura

    J Comput Assist Tomogr

    (1996)
  • B. Künzlberger et al.

    Migraine ophthalmique with reversible scotomas after sclerotherapy with liquid 1% polidocanol

    Dermatologic Surgery

    (2006)
  • International Headache Society. International Headache Society classification ICHD - II. Available at...
  • D. Cologno et al.

    A prospective study of migraine with aura attacks in a headache clinic population

    Cephalalgia

    (2000)
  • M.B. Russell et al.

    A nosographic analysis of the migraine aura in a general population

    Brain

    (1996)
  • M.K. Eriksen et al.

    Clinical characteristics of 362 patients with familial migraine with aura

    Cephalalgia

    (2004)
  • F. Brighina et al.

    Reduced cerebellar inhibition in migraine with aura: A TMS study

    Cerebellum

    (2009)
  • H. Bolay et al.

    Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model

    Nat Med

    (2002)
  • W.M. Mulleners et al.

    Visual cortex excitability in migraine with and without aura

    Headache

    (2001)
  • S.K. Aurora et al.

    The threshold for phosphenes is lower in migraine

    Cephalalgia

    (2003)
  • S.K. Aurora et al.

    The occipital cortex is hyperexcitable in migraine: Experimental evidence

    Headache

    (1999)
  • S.K. Aurora et al.

    Transcranial magnetic stimulation confirms hyperexcitability of occipital cortex in migraine

    Neurology

    (1998)
  • L. Battelli et al.

    Transcranial magnetic stimulation of visual area V5 in migraine

    Neurology

    (2002)
  • M. Gerwig et al.

    Visual cortex excitability in migraine evaluated by single and paired magnetic stimuli

    Headache

    (2005)
  • S. Gunaydin et al.

    Motor and occipital cortex excitability in migraine patients

    Can J Neurol Sci

    (2006)
  • G. Dalla Volta et al.

    Prevalence of patent foramen ovale in a large series of patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype

    J Headache Pain

    (2005)
  • G. Ferrarini et al.

    High prevalence of patent foramen ovale in migraine with aura

    J Headache Pain

    (2005)
  • E. Agostoni et al.

    Migraine and cerebrovascular disease

    Neurol Sci

    (2007)
  • Z.M. Cader et al.

    Significant linkage to migraine with aura on chromosome 11q24

    Hum Mol Genet

    (2003)
  • D. Cologno et al.

    Migraine with aura: A review of 81 patients at 10-20 years’ follow-up

    Cephalalgia

    (1998)
  • V. Ulrich et al.

    Evidence of a genetic factor in migraine with aura: A population-based Danish twin study

    Ann Neurol

    (1999)
  • B.K. Rasmussen et al.

    Migraine with aura and migraine without aura: An epidemiological study

    Cephalalgia

    (1992)

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    Disclosure: The authors have no financial or other relationships that might lead to a conflict of interest.

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    Copyright © 2011 American Optometric Association. Published by Elsevier U.S.A. All rights reserved.