• Neuro-Ophthalmology/Orbit

    The authors present the case of a 23-year-old woman with persistent monocular visual loss in the right eye after a retinal migraine and optic nerve involvement.

    They note that retinal migraine is a rare entity characterized by headache associated with transient monocular visual loss. While fully reversible and a normal ophthalmological examination between the attacks is the hallmark, persistent visual loss has been reported.

    In this patient, MRI showed signal hyperintensity and a slight distention of the perioptic subarachnoid space in the right optic nerve, suggesting optic nerve involvement in retinal migraine.

    The patient had a history of headache of moderate intensity beginning in early adolescence with episodes of unilateral fronto-temporal pulsating pain with side alternation, often associated with transient visual disturbances. These were characterized by a partial monocular visual field defect, often confined to a localized part of the unilateral visual field, lasting a few minutes and with side alternation of the affected eye among headache attacks.

    She came to the emergency room during an episode of headache with unilateral eye disturbance, although the eye changes did not improve spontaneously. The visual disturbance was confined to the inferior part of the visual field of the right eye and was characterized by an area of glittering with superimposed blindness.

    The authors say that the finding of chronic elements, such as a pale and atropic disk and atrophy of the optic nerve, suggests that the previous repeated attacks could have left some kind of sequelae and these might have facilitated the development of persistent symptoms. They say this case suggests that recurrent attacks of retinal migraine secondary to vasospasm may weaken the optic nerve, leaving it vulnerable to a final migraine attack that provokes a permanent visual loss.

    They conclude that the presence of optic nerve involvement, if confirmed by further reports and data, can help elucidate the pathogenesis of retinal migraine.