A Case of Prolonged Bilateral Inferior Altitudinal Visual Field Defect in a Young Migraineur

Jung Taeck Hong; Hyun Taek Lim

doi:10.3341/jkos.2010.51.11.1537

Journal List > J Korean Ophthalmol Soc > v.51(11) > 1008697

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Hong and Lim: A Case of Prolonged Bilateral Inferior Altitudinal Visual Field Defect in a Young Migraineur

Original Article

J Korean Ophthalmol Soc 2010;51(11):1537-1542.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.11.1537

A Case of Prolonged Bilateral Inferior Altitudinal Visual Field Defect in a Young Migraineur

Jung Taeck Hong, MD, Hyun Taek Lim, MD

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address reprint requests to Hyun Taek Lim, MD Department of Ophthalmology, Asan Medical Center #388-1 Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Tel: 82-2-3010-3672, Fax: 82-2-470-6440, E-mail: htlim@amc.seoul.kr

Received 2 May 2010 Accepted 18 August 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of prolonged bilateral inferior altitudinal visual field defect in a young migraine patient.

Case summary

A 13-year-old female patient presented with bilateral disturbance of visual acuity and visual field, which had begun one month before. She complained of headache, with recently increasing frequency, that occurred 3 or 4 days a week for about 2∼3 hours duration, sometimes accompanied by nausea and located in the frontotemporal and retrobulbar area. Brain magnetic resonance imaging showed no abnormal finding in the brain and orbit. Her visual acuity was hand motion in both eyes and Humphrey visual field test showed bilateral inferior altitudinal visual field defect. Pupillary re-sonse was normal and extraocular muscle movement, anterior segment and fundus were also normal in ophthalmologic examination. Her best corrected visual acuity was 1.0 in both eyes by fogging method, but bilateral inferior altitudinal visual field defect persisted for 6 months follow-up.

Conclusions

Bilateral inferior altitudinal visual field defect can be developed in a migraine patient without other causes. Careful examinations to rule out other causes such as ischemic optic neuropathy or brain infarct should be performed in a migraine patient who complains of visual disturbance.

Keywords: Aura, Migraine, Visual field defect

References

1. Choi WJ, Chung J-Y, Lee DI, et al. Comparison of effectiveness of stellate ganglion block between chronic tension headache and chronic migraine patients. Korean J Anesthesiol. 2006; 51:201–6.

2. Lewis RA, Vijayan N, Watson C, et al. Visual field loss in migraine. Ophthalmology. 1989; 96:321–6.

3. Razeghinejad MR, Masoumpour M, Bagheri MH. Migrainous prolonged and reversible bilateral inferior altitudinal visual field defect. Headache. 2009; 49:773–6.

4. Relja G, Granato A, Ukmar M, et al. Persistent aura without infarction: description of the first case studied with both brain SPECT and perfusion MRI. Cephalalgia. 2005; 25:56–9.

5. Kang SJ, Kim JK, Kim MJ, et al. A case of recurrent and transient unilateral visual disturbance improved by beta-blocker: a variant of retinal migraine? Korean J Headache. 2007; 8:97–9.

6. Falavarjani KG, Sanjari MS, Modarres M, Aghamohammadi F. Clinical profile of patients with nonarteritic anterior ischemic optic neuropathy presented to a referral center from 2003 to 2008. Arch Iran Med. 2009; 12:472–7.

7. Mensah A, Vignal-Clermont C, Chadi M, et al. Dysthyroid optic neuropathy: Atypical initial presentation and persistent visual loss. Orbit. 2009; 28:354–62.

8. Lee AG, Brazis PW, Miller NR. Posterior ischemic optic neuropathy associated with migraine. Headache. 1996; 36:506–10.

9. González-Martín-Moro J, Pilo-de-la-Fuente B, Moreno-Martín P. Migraineous anterior optic ischemic neuropathy. Arch Soc Esp Oftalmol. 2009; 84:473–6.

10. Trobe JD. The neurology of vision. New York: Oxford University Press;2001. p. 295.

11. Tzourio C, Tehindrazanarivelo A, Iglésias S, et al. Case-control study of migraine and risk of ischaemic stroke in young women. BMJ. 1995; 310:830–3.

12. Agostoni E, Rigamonti A. Migraine and cerebrovascular disease. Neurol Sci. 2007; 28(Suppl 2):S156–60.

13. Trego ME, Pagani JM. Three presentations of monocular vision loss. Optometry. 2006; 77:82–7.

14. Streifler J-Y, Eliasziw M, Benavente OR, et al. North American Symptomatic Carotid Endarterectomy Trial. The risk of stroke with first-ever retinal vs hemispheric transient ischemic attacks and high-grade carotid stenosis. Arch Neurol. 1995; 52:246–9.

15. Lashley KS. Patterns of cerebral integration indicated by the scotomas of migraine. Arch Neurol Psychiatry. 1941; 46:331–9.

16. Dahlem MA, Engelmann R, Lowel S, Muller SC. Does the migraine aura reflect cortical organization? Eur J Neurosci. 2000; 12:767–70.

17. Moskowitz MA. Basic mechanisms in vascular headache. Neurol Clin. 1990; 8:801–15.

18. Wilkins A, Nimmo-Smith I, Tait A, et al. A neurological basis for visual discomfort. Brain. 1984; 107:989–1017.

19. Wakakura M, Ichibe Y. Permanent homonymous hemianopias following migraine. J Clin Neuroophthalmol. 1992; 12:198–202.

20. Luda E, Bo E, Sicuro L, et al. Sustained visual aura: a totally new variation of migraine. Headache. 1991; 31:582–3.

Figure 1.

Fundus photographs showed normal optic disc and fundus in both eyes.

Figure 2.

(A) Humphrey visual fied test and (B) Goldmann visual field test showed bilateral inferior altitudinal visual field defect respecting the horizontal meridian.

Figure 3.

Fluorescein angiography did not show any leakage or abnormal finding in optic disc and retina at recirculation phase.

Figure 4.

Humphrey visual fied test at 6 month follow-up showed persist bilateral inferior altitudinal visual field defect.

Figure 5.

Brain SPECT images showed diffuse patchy cortical distribution of Tc-99m-ECD (technetium-99m-ethyl cysteinate dimer), in particular significant decrease of cortical perfusion in right temporal (black arrow) and occipital lobe (gray arrow).

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