Monday, October 3, 2011

scintillating scotoma

image from myaspiebrain
Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient's point of view.  After all these years, I had my first (and hopefully last) scintillating scotoma while sitting on the couch playing "words with friends" on my ipad and watching TV.  A scotoma is a partial loss of vision in a normal visual field.  Scintillate is flashing, sparkles.  Put them together and you have moving, flashing sparkles with a blind spot in your eyes.

This visual aura was first described in the 19th century  by a Dr. Hubert Airy who had migraine headaches.  The visual sparks and flashes are in a zig-zag pattern and they can precede a migraine headache or occur without any pain.   The scotoma affects both eyes and closing one or the other does not make it go away.  Sometimes the term "ocular migraine" or "retinal migraine"  are used to describe this phenomenon but these involve only one eye, not both.  The terms are often used interchangeably but they are not the same.

The cause of these migraine auras are not understood.  Only 20-30% of people with migraine headache experience them.  The visual defect occurs not in the eyes, but in the visual cortex which is located in the back of the brain in the occipital lobe.

My scintillating scotoma lasted about 15 minutes and it took me awhile to figure out what it was.  I went outside and gazed into the distance and it persisted.  I closed one eye and then the other and it was still there.  I never got a headache or any other symptoms.  Then it just went away.

The next time a patient with classic migraine with aura comes in,  I will have a better understanding of the prodrome before the headache.  I hope I don't have to experience the entire headache.  I could do without that.


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Scott said...

I’ve been suffering from scintillating scotoma since I was about 15. I am a 51 year old man. Migraine headaches accompanied them in my youth but not as an adult. I have been tracking them the last few years as they have increased from a few a year to every few days - infrequently two or three a day. Since the first of this year, I have experienced scintillating scotoma 34 times.

In scanning these posts, I found interesting the number of people who report scotomas migrating to the left and out of their vision. Mine always move to the right. I am predominantly left handed and wonder if that could explain the difference.

Ian Wardell said...

Scott, have you tried to identify the triggers i.e what it is that brings them on? I'm averaging about 8 episodes a year (for past 5 years or so) so it's difficult for me to identify these triggers, but for definite exercise is one of them. I also strongly suspect eating smoked mackerel and kippers. Also I think, thus far, I've only ever had these scintillating scotoma on an empty stomach. Also worrying about my long term future might also be a trigger. Finally, I kinda suspect 2 or more triggers might have to occur together before bringing on the SS.

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