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      Detection of Migrainous Infarction with Formal Visual Field Testing: A Case Report

      case-report

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          Abstract

          Introduction

          Cerebrovascular accidents (CVA) of the posterior circulation are a rare complication of migraine, and present with atypical CVA symptomatology.

          Case Report

          A 49-year-old-male presented with complaint of persistent visual aura and resolved mild cephalgia. His exam corroborated his reported incomplete left inferior quadrantanopia, and was confirmed by immediate formal optometry evaluation. Occipital CVA was confirmed on admission.

          Conclusion

          Migrainous strokes of posterior circulation should be considered as a potential diagnosis in any headache patient with persistent visual aura. This case suggests that incorporation of formal visual field testing in the emergent setting can shorten the time required for diagnosis in certain circumstances.

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          Most cited references10

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          Homonymous hemianopia in stroke.

          Xiaojun Zhang, Sachin Kedar, Michael Lynn … (2006)
          Previous reports have suggested that most cases of homonymous hemianopia (HH) are caused by occipital stroke. However, these reports have not always been supported by brain imaging. We reviewed the medical records of all patients seen in our unit between 1989 and 2004 who had HH documented by formal perimetry or confrontation visual fields and had undergone brain imaging. HHs were divided into those caused by stroke and by non-stroke conditions. The clinical and visual field characteristics were compared in the two groups. Among 850 patients with 902 HHs, 629 (69.7%) resulted from stroke, of which 531 (84.4%) were from infarction and 98 (15.6%) from primary intraparenchymal hemorrhage. Non-stroke causes included head trauma (123), brain tumor (102), neurosurgical procedures (22), multiple sclerosis (13), and miscellaneous conditions (13). Occipital lesions most commonly resulted from stroke. The configuration of the HH did not predict where in the retrochiasmal visual pathway the responsible lesion lay. Ischemic stroke causes most HHs from lesions in the occipital lobe that generally do not produce other neurologic manifestations. The configuration of the HH does not predict the location of the lesion within the retrochiasmal visual pathway.
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            Homonymous visual field defects and stroke in an older population.

            Sean P Healey, Steven Cumming, Andrew J. Currie … (2002)
            The objective of the present study was to describe the prevalence of homonymous visual field defects in a defined older urban population and associations with self-reported stroke. Homonymous visual field defects were assessed from screening automated visual field tests of both eyes in 3654 persons aged > or =49 years who were participating in the Blue Mountains Eye Study. This represented 82.4% of eligible residents from a defined area west of Sydney, Australia. A detailed eye examination was performed, and the medical history was taken. Masked grading of visual fields was used to classify the presence of homonymous visual field defects. Homonymous visual field defects were found in 25 persons (prevalence 0.8%, 95% CI 0.5% to 1.1%). Stroke history was reported by 194 participants (5.3%, 95% CI 4.6% to 6.1%). A strong relationship was found between homonymous visual field defects and history of stroke, age-, and sex-adjusted odds ratio (OR) 23.4 (95% CI 9.9 to 55.7). Homonymous field defects were present in 8.3% of all persons who reported experiencing a stroke. Among those with homonymous field defects, 52% reported a history of stroke. Only 2 of 10 persons (20%) with homonymous field defects without a history of stroke reported having stopped driving, whereas 6 of 9 (67%) reporting stroke had stopped driving (P=0.07). Increasing age (OR 1.4 per decade, 95% CI 1.2 to 1.8) was significantly associated with homonymous visual field defects, with adjustment for sex, whereas a history of hypertension (OR 2.7, 95% CI 1.2 to 6.1), diabetes (OR 2.1, 95% CI 1.4 to 3.2), and renal impairment (OR 2.8, 95% CI 1.0 to 8.1) also was associated, with adjustment for age and sex. This study provides accurate prevalence data for homonymous visual field defects in an older population. About half the participants did not report stroke.
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              Differences in Ischemic Anterior and Posterior Circulation Strokes: A Clinico-Radiological and Outcome Analysis

              Elodie Zürcher, Benjamin Richoz, Mohamed Faouzi … (2018)
              There are limited data comparing posterior (PC) and anterior (AC) circulation acute ischemic strokes (AIS). We aimed to identify specific features of PC and AC strokes regarding clinical, etiological, radiological, and outcome factors.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Pract Cases Emerg Med
                Journal ID (iso-abbrev): Clin Pract Cases Emerg Med
                Title: Clinical Practice and Cases in Emergency Medicine
                Publisher: University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine
                ISSN (Electronic): 2474-252X
                Publication date Collection: August 2020
                Publication date (Electronic): 09 July 2020
                Volume: 4
                Issue: 3
                Pages: 366-370
                Affiliations
                [* ]Naval Hospital Okinawa, Department of Emergency Medicine, Okinawa, Japan
                [† ]Naval Hospital Okinawa, Department of Internal Medicine, Okinawa, Japan
                [‡ ]Naval Hospital Okinawa, Department of Optometry, Okinawa, Japan
                Author notes
                Address for Correspondence: William Bylund, MD, Naval Medical Center Portsmouth, Department of Emergency Medicine, 620 John Paul Jones Circle, Portsmouth, VA 23708. Email: william.e.bylund@ 123456mail.mil .
                Article
                Publisher ID: cpcem-04-366
                DOI: 10.5811/cpcem.2020.4.46387
                PMC ID: 7434247
                SO-VID: 7a1ebf00-d507-4ce8-af02-fe5323022669
                Copyright © Copyright: © 2020 Bylund et al.
                License:

                This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 02 January 2020
                Date revision received : 18 April 2020
                Date accepted : 30 April 2020
                Categories
                Subject: Case Report

                Keywords: cerebrovascular accident,homonymous hemianopsia,migraine
                Data availability:
                Keywords: cerebrovascular accident, homonymous hemianopsia, migraine

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