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Avatar universal

visual Migrane or TIA/Stroke?

At 39 I was diagnosed with a TIA/mini-stroke.

Initial Sympton:

White light covered my sight and I started to mumble and unable to formulate words/or communicate with my co-workers.  I went home "slept it off" and the next day returned to the office however, I couldn't put my thoughts together while crafting emails and went to the emergency room (Navy Medical Portsmouth, Va).  A highly respected neurologist, after many many tests...finally focused on my heart and eventually found a significantly large PFO.  They repaired the hole w/a patch in Bethesda, MD...However, after a month, I began having mini episodes similar but less intense.  It's been going on ever since.  

Description: 20 minutes of a small white polygon center wrapped with a thin ring of multi-colored wavy lines that increase in size until it eventually dissapears. I'm left with a stuper like feeling unable to mentally function effectively for at least an hour.   I went back to the same neurologist and he finally said it could be Visual/retina Migrane?  

Family History:
My mother has had long and painful headache related migranes all her life.  I haven't had a problem until 2004.

My headache isn't a concern regarding actual pain. It's minimal after the episode (feels like my brain was dropped and then put back in my skull) it lingers like a bruise for about 1.5 days.  My fear is that I'm not going to recover my cognizant abilities or drop dead after one of these episodes?  I work in Computer IT/IA security and I truly drop sync after one of these events.   I'm a 43 male slightly near sighted and wear mild prescription glasses.  This doesn't seem to be an eye issue.  I like coffee, normal diet.  It seems that to much sun or dihidration can trigger an event.  they have decreased in the last year but sometimes come in two's or three's.  

Any suggestions?
6 Responses
Avatar universal
MEDICAL PROFESSIONAL
Hi,

By PFO, you mean a patent foramen ovale?

There seems to be a relationship between an increased incidence of a TIA and the presence of a patent foramen ovale.

At this point , a migraine may still be a differential considering that your patent foramen ovale has been repaired.Yet, a TIA is not completely excluded. TIA is usually difficult to assess diagnostically since symptoms may resolve within 24 hours.

Were your neck vessels and blood vessels in your extremities evaluated? A thromboembolism has to be ruled out. A thrombus ( a large blood clot) in the peripheral vessels may throw smaller blood clots (emboli) which may block blood vessels in the brain thus causing the neurological deficits .

Discuss with your physicians the use of anticoagulation therapy and further evaluation. The side effects of anticoagulation therapy has to be weighed against the future risk of stroke incidence.

Meanwhile, stay calm and relax.Unnecessary worryimg would not help. Just keep a close follow up with your physician.

I hope this helps. Keep us posted regarding your progress.
Avatar universal
Since 04, how bad have the headaches been?  Were they diagnosed or treated?  Were you taking anything for them?  Have you been working on "differnet" type of IT work - like did you move departments from software development to network support etc..?  Did your department just get a new shipment of laptops from a new company and you have been the one "imaging" all of them?  Well I looked back at your post, you work in IT security.

I know if you told me exactly what you do - you "would have to kill me" so I won't ask but there is an issue with people who get migraines and computer screens.  WE ARE NOT TALKING EYESTRAIN - do you remember years ago all those studies where kids with video games were having seizures and headaches.  There was actually an A class motion picture that they had to stop screening and edit because a certain number of people were getting "sick" after seeing it.  You can actually see a progression of colors/motions/flickers that can cause migraine/seizure/ not sure about TIA - can't TIA symptoms be the same as seizure symptoms.  Did the TIA leave any deficit on an MRI?
I want to know how long from first attack to PFO closure because I work in managed care and that is a shocker - I mean a good shocker-but hurts in diagnosis now - do you think the PFO closure helped.  How many episodes did you  have before the procedure was done?

I have severe migraines and about 8 years ago I had a desktop with one of those old monitors - mine flickered all day and everyone could see it - everyone laughed because it would make them carsick - no matter how hard I tried I couldn't see any flicker.  
My daughter has her own laptop and she can't have flickering lights on it at all, when I leave a room I have to tell her so she can cover her eyes or the light going on and off will give her a headache.  She can faint from it - seriously.  Sunlight, forget it.
Believe it or not, men your age have TIA's and has anyone done a study to see if it is increasing(brother in law just had one).  You should ask your doctor about taking magnesium because genetically you probably have weaker blood vessels.  And of course there are meds - I know this sounds stupid but try not to look at every screen with flashing bunnies/ or your head on an elf that each user has.
Twenty-five years ago there were Ergonomic studies done by Grandjean (a leader in his field) they clearly showed that the old black/green DOS prompt screens were the best for workers.  I don't know where Grandjean is today but we have played havoc with the "flicker fusion frequency" of eye movement on PC's.
Avatar universal
First, thank you both for responding.

To Answer Dr. Vanessas's questions:
1. It was a PFO as defined.
2. Regarding Thromboembolism, I'm not sure. They did a hemesperical blood flow through my brain and used dye while imaging my circulation throughout my upper body.  and I don't recall this being a topic though.  They had me swallow a camera twice and pushed air threw my arm through my heart while monitoring a dopler radar my temples.  That's what confirmed my PFO.  

Medicine: I was on cumiden while awaiting heart surgery and then remained on a statin for 6-8 months post care.  I was told to take one asprin a day after that (as I do).  

The visual and post stuper like feelings happened while I was taking the medicine and awaiting surgery and afterwards.  I guess that's the most dishearting issue.  All the drama w/the heart and still left w/these wierd events?

For "LifesAHedache":  This flickering is curious and I can't watch a interactive game such as "Doom" becuase of this reaction (like motion sickness). I can ride the seven seas w/out getting sick (sea legs)...I can't say I can specifically corelate this phenominan to computer screens.  I've worked with the entire evolution of computer screens starting w/teletype/command line/CRT/LCD etc. for 26 years.  the first major visual/mental event happened while I was in a  heavy leadership role discussing issues in a office.  I've had these events while golfing, hunting, at home away from computers.  Once it starts, all I can do is stop and let it pass.

Thanks and appreciate your comments.

Steve    
Avatar universal
Thank you so much for taking the time to answer.  To me it is very interesting that you can't watch a game like doom because of the motion sickness feeling.  The hypothesis is that the "DOOM" effect results in changes in neurotransmitter functioning in the brain and there is no set time as to how long it takes for your episode to then occur.  And let me reitterate, I am not a doctor but I love to research and I personally feel this is an important area that has not had enough.
Doom input would use a whole different part of the brain than seven seas (sea legs), vision vs. balance.

But, for your current concern.  The most important thing you can tell the doctor and I would leave him a voice mail is that the PFO closure DID lessen the severity of the attacks.  Are you sure the patch can't leak?  Remember tons of people have PFO's, never know it and are fine. So I know its hard but don't freak.  He will probably say no, it can't leak and that it wouldn't be enough to cause symptoms.  If you look up MIST II it will show you how the blood flows and causes the brain impact.  I apologize if you've already been through all that.
The doctor isn't worried because your symptoms are consistent with the Aura before several types of Migraines.  And for you to get a PFO closure after presenting with one TIA - this neurologist is probably top-notch and treatment aggressive.  Remember, before you had surgery he had to do a thorough neurological workup and he isn't seeing anything now for alarm cause.  All the touching your fingers to your nose and walking on your tippy toes is each done for a certain reason.
If he thinks visual/retina migraine - did he give you a preventative medicine for that.  Topamax (anti-seizure) med might really help and firm up his diagnosis, plus its anti-seizure  - but you have had a TIA and I'm not a doctor - but if he says it wouldn't hurt you a bit to try - I would try it.  I would completely stay away from Triptans like Imitrex.  They can affect blood vessels/chest pain - not worth the risk - my opinion.  Topamax may really help in this case but he'll tell you if it is contraindicated in TIA patients.  
Also
golfing - light changes with excertion
hunting- light changes, excertion, adrenaline
home - TV on??  Never have a TV on while sleeping, NEVER fall asleep watching TV at any time of day.

If you can identify time/events where your episodes happen - then ask the doctor if two hours before you can take two or three advil and drink a propel water.  Just my two cents.  Take Care and again sorry for the long post.
Avatar universal
MEDICAL PROFESSIONAL
Hi,

There seems to be an association between an increased prevalence of Migraine with aura among persons with PFO. Some studies reported that their condition improved after a PFO repair.

Your physician may be able to help you.At this point a TIA or even a seizure may be a probable differential. It is relevant however that your condition has been present prior to your PFO diagnosis and has decreased in frequency and severity after the repair.Is this correct?

Was an EEG done? When is your next ff up consultation?

I hope this helps.
Avatar universal
hi, well i had the pfo closure, which will be a month on the 12 day of june and i have two severe miganes where i don't see well for thirty min. then its severe pain generally in my left eye,with alot of pounding. i also have chest pain that comes annd goes. what do you all think? the hole in my heart was large 2.5 centimeters, the dr. told me i was lucky i didn't have a stroke.......has anyone had these problems???? wondering.... any suggestions.....stay in pain.....
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