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Scintillating scotoma is a common visual aura that was first described by 19th-century physician Hubert Airy (1838–1903). Originating from the brain, it may precede a migraine headache , but can also occur acephalgically (without headache), also known as visual migraine or migraine aura. [ 4 ]
Acephalgic migraine (also called migraine aura without headache, amigrainous migraine, isolated visual migraine, and optical migraine) is a neurological syndrome.It is a relatively uncommon variant of migraine in which the patient may experience some migraine symptoms such as aura, nausea, photophobia, and hemiparesis, but does not experience headache. [1]
Visual auras can be simple or complex. Simple visual symptoms can include static, flashing, or moving lights/shapes/colors caused mostly by abnormal activity in the primary visual cortex. Complex visual auras can include people, scenes, and objects which results from stimulation of the temporo-occipital junction and is lateralized to one hemifield.
Visual symptoms: “Visual aura is the most common,” says Dr. Natbony. “There are different types of visual aura, but it usually is a partial loss of vision that’s surrounded by colors ...
Scintillating scotoma is a common visual aura in migraine. [4] Less common, but important because they are sometimes reversible or curable by surgery , are scotomata due to tumors such as those arising from the pituitary gland , which may compress the optic nerve or interfere with its blood supply.
Illusory palinopsia is often worse with high stimulus intensity and contrast ratio in a dark adapted state.Multiple types of illusory palinopsia often co-exist in a patient and occur with other diffuse, persistent illusory symptoms such as halos around objects, dysmetropsia (micropsia, macropsia, pelopsia, or teleopsia), Alice in Wonderland Syndrome, visual snow, and oscillopsia.
Photopsia; This is an approximation of the zig-zag visual of a scintillating scotoma as a migraine aura. It moves and vibrates, expanding and slowly fading away over the course of about 20 minutes.
The aura phase of migraine can occur with or without a headache. Ocular or retinal migraines happen in the eye, so only affect the vision in that eye, while visual migraines occur in the brain, so affect the vision in both eyes together. Visual migraines result from cortical spreading depression and are also commonly termed scintillating scotoma.