Ocular Migraine?

[David Bryan]

48 year old male;  healthy entire life;  

Chronological Review:  In May 2006, started experiencing subtle vertigo/dizziness periodically when walking down a long hallway that had black & white floor tiles.  In August 2006, started experiencing eye dryness and vision blurriness when on the computer for long periods (I’m a programmer).  In November 2006, experienced first visual distortion (blind spots in center vision and squiggly lines in peripheral vision) that lasted 20 minutes.  Had five/six additional visual distortions the following month, each episode being minor (lasting less than 5 minutes), less one episode which lasted 30-40 minutes with substantial brain fog.  Doctors suspected TIA’s or ocular migraines.  MRA in December 2006 revealed 90% blocked vertebral artery.  Major symptoms in December 2006:  brain fog, memory loss, eye dryness, vision blurriness, periodic vertigo/dizziness.  Eye exam by opthamologist in December 2006 cited no issues.  However, the exam was extremely painful when the doctor shown the light into my eyes following dilation.  I’ve had this exam done before but it was not nearly as painful as this exam.  Cerebral angiogram in February 2007 revealed no blockages;  however, symptoms cited above persisted.  Subsequent review of MRA by another radiologist attributed the vertebral “blockage” as an anomaly.  In April 2007, my neurologists suspected my symptoms were migraine related and ask that I give it a couple months to if the symptoms subside.  The symptoms persisted.  In June 2007, he prescribed Topamax which did not work for me.  In July 2007, he prescribed Depakote which has helped some with all symptoms (brain fog, memory loss, vertigo/dizziness, eye dryness, vision blurriness).

I would appreciate observations and/or further thoughts regarding diagnosis/treatment.

Thanks.

[John C Hagan]

As I interpret you answer you do NOT have a vertebral artery occlusion. Have you had carotid arty doppler tests? Heart study including an echocardiogram? Like many of the "mystery" hard to diagnose problems that reoccur on this forum, I think you would be best served by seeing a neuro-ophthalmologist.

Foggy vision and dry eyes with computer work is usually garden variety dry eyes. We've discussed this several times on the two eye forums. We would recommend for that artifical tears before starting the computer work, every 10-15 minutes looking across the room away from the screen and blinking hard 3-5 times and being sure you computer work station does not have a fan, air conditioner or heating vent blowing across you.

JCH MD Ophthalmologist, Eye MD

[David Bryan]

The cerebral angiogram in February 2007 revealed no blockages and another radiologist concluded the "blockage" on the MRA was an anomaly.  A physical in December 2006 showed blood pressure is in the normal range (If memory serves, 125 over 80 range), cholesterol was 160 and 90, current body weight is 193 at 6'0" (could stand to loose about 10 pounds).  Blood work was all good.  My mom had migraines but those stopped after her hysterectomy.  No family neurological disorders.  I don't smoke.

Triggers:  I'm not sure that my symptoms every really goes away.  Some days are better than others but I typically have one or more of the symptoms.  My focus (brain fog) and memory have degraded.  I expect some degradation from age but I believe this to be excessive.  Depakote has helped.  I have noticed that my vision becomes foggy and my eyes become dry if I work at the computer for an extended period and when I'm in a room with florescent lighting.

Thanks.

[John C Hagan]

Hello David, sounds like a rough couple of years. From your history I'm not sure if you do or do not have blockage of the vertebral artery. Please clarify.  Also what about your blood pressure, serum cholesterol and body weight?  Family history of migraine or neurological disorder? Do you smoke? Have you identified any "triggers" for these episodes?

JCH MD