permanent migraine aura

i posted a while ago about spots in my vision that look like that afterimage of a camera flash and then fade to a PERMANENT blind spot over a period of weeks (visible on amsler grid). i have about 20 ot these spots scattered throughout my vision in both eyes (different in each eye).

anyway, i ended up having an OCT and the doctor told me there was "no disease present at this stage".

my next step is to consult a neuologist or neuro-opth, as a condition called "perisitent migraine aua without infarction" was mentioned to me.

i have suffered regular migraines with aura since i was a kid, though they are few and far between now (I am 39), but the bilateral scintillating scotoma that characterizes these in NO WAY resembles the spots i experience with the other.

my question is, have you heard of this condition and does it sound like something that could explain my symptoms? i really don't want to pursue a whole lot of expensive tests and waste time and money if it does not sound like a valid diagnosis to pursue.

[John C Hagan III, MD, FACS, FAAO]

Your symptoms do cause concern because of these permanent blind spots. In spite of the extra time and expense I would urge you to continue your work up. I would strongly suggest a neuro-ophthalmology consultation to include a visual field examination to try and map out these blind spots. Most large and some mid size cities have neuro-ophthalmologists. Usually ophthalmology departments affiliated with medical schools will have one on their staff.

Visual field tests done on patients with migraines but no complaint of blind spots show a significant presence of undiagnosed and unrecognized blind spots. So migraine causes small infarcts in the brain more often than recognized.

Mel07green I would continue with your work-up with a neuroophthalmologist (EyeMD) as your symptoms are worrisome.

JCH MD  Eye MD

[mel07green]

i guess this would be considered a "diagnosis of exclusion"??

that doesn't sit real comfortable with me - are suggestions?

[mel07green]

thank you so much, doctor. i have had a field test - two actually. and they came back in normal range. though there were a few suspect spots, they were isolated and did not correlate to the spots on the amsler grid. maybe they are too small?

so migraines can do permanent damage?

the doctor mentioned retinal migraines, because my symptoms are in one eye at a time. would that mean my retina is being progressively damaged because of reduction in the blood supply? nothing was "seen" during dilated exam or OCT to explain the spots on the amsler grid and was given reassurance and sent of my way.

it was a second doctor who mentioned migraines.

[circumspect]

Hello Mel   Yes migraines can in rare instances cause an infarction in the brain equivalent to a small stroke or retinal migraine can in rare instances cause a retinal vascular occlusion (eye stroke equivalent).

Neuro-ophthalmology problems are notoriously difficult sometime to pin down that's why it's evolved into a separate specialty.

JCH MD

[mel07green]

if there were any damage to the retina, would that have showed up on an OCT or during a dilated exam?

[circumspect]

OCT is excellent for some optic nerve problems and many macular problems.  However there are some diseases that might not show up with OCT and dilated exam especially if the problem were in the optic nerve behind the eye or in the brain in the centers associated with vision.

JCH MD

[mel07green]

thank you so much for your thorough and patient answer!

[mel07green]

one more question just occurred to me - if the problem wwas with the optic nerve BEHIND the eye or in the brain, wouldn't the symptoms be binocular and symetrical?

[circumspect]

The optic nerve carries fibers from only one eye until it reaches the base of the brain just above the pituitary gland. This is called the optic chiasm (shaped like letter "X". At the chiasm some fibers from each optic nerve cross over to the opposite side of the brain from there on back it's known as the optic track and latter the optic radiations.

Lesions from the chiasm forward affect only one eye, lesions from the chiasm backward can cause symptoms in both eyes.

JCH MD

[mel07green]

thanks again ... based on my description, is it possible for you to hazzard a guess as to location?

[John C Hagan]

Sorry, Mel, I'm not a hazzard a guess kind of guy.  

JCH

[michaeljames]

A related discussion, persistant migraine aura debate was started.