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Tezuka T, Shibata M, Hanaoka H, Izawa Y, Kikuchi T, Akino K, Ozawa Y, Saito M, Kaneko Y, Nakahara J, Takizawa T. Systemic lupus erythematosus mimicking retinal migraine: a case report. Cephalalgia 2023; 43:3331024231219477. [PMID: 38069834 DOI: 10.1177/03331024231219477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Retinal migraine is a diagnosis of exclusion and is characterized by repeated episodes of transient monocular blindness associated with migraine. We report a case of systemic lupus erythematosus with acute episodes mimicking retinal migraines. CASE REPORT A 46-year-old woman with a history of migraine with aura since her 20s and Evans syndrome presented with episodic transient monocular blindness. Retinal migraine was considered as the cause, and migraine prophylaxis initially reduced its frequency. After 5 months, the frequency increased, with chilblain-like lupus lesions on her extremities. Laboratory testing revealed lymphopenia and hypocomplementemia, fulfilling the diagnostic criteria for systemic lupus erythematosus, which may have caused Evans syndrome and transient monocular blindness, mimicking retinal migraines. After intravenous methylprednisolone and rituximab therapy, the transient monocular blindness episodes did not recur. CONCLUSION Given the clinical presentation, systemic lupus erythematosus should be considered as a cause of transient monocular blindness and should be distinguished from retinal migraine.
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Affiliation(s)
- Toshiki Tezuka
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Shibata
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Hironari Hanaoka
- Department of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikane Izawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Kikuchi
- Department of Hematology, Keio University School of Medicine, Tokyo, Japan
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kunihiko Akino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Department of Clinical Regenerative Medicine, Fujita Medical Innovation Center Tokyo and Eye Center, Fujita Health University, Haneda Clinic, Tokyo, Japan
| | - Masataka Saito
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Department of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
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Sirbu CA, Nicolescu VM, Nițiș AO, Costache RS, Ștefani C, Mitrică M, Luncă DC, Anghel D. Retinal migraine, a contentious clinical entity. ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
" Retinal migraine (ophthalmic migraine, ocular migraine, anterior visual pathway migraine) is a rarely encountered medical condition, but with an interesting and complex clinical presentation. The goal of this article is to compile the literature on retinal migraine, detailing nomenclature, pathophysiology, differential diagnosis, and medical investigations including newer imaging modalities, like optical coherence tomography (OCT). We will approach topics of great concern such as risk factors, complications, treatment, and management of this condition. Retinal migraine is mainly a diagnosis of exclusion and it must be isolated from transient monocular vision loss (TMVL) developed from other causes, for instance, papilledema, giant cell arteritis, carotid artery disease (amaurosis fugax), intermittent angle closure glaucoma, and others. Its treatment is similar to migraine treatment; topiramate, amitriptyline, and nortriptyline are some of the pharmacological drugs successfully used."
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Morishita N, Yamanaka G, Go S, Takeshita M, Tsutsumi N. Pediatric retinal migraine: A case report and literature review. Pediatr Int 2022; 64:e14922. [PMID: 34897886 DOI: 10.1111/ped.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Natsumi Morishita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan.,Department of Pediatrics, Kohsei Chuo General Hospital, Tokyo, Japan
| | - Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Soken Go
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mika Takeshita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Norito Tsutsumi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan.,Department of Pediatrics, Kohsei Chuo General Hospital, Tokyo, Japan
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Chong YJ, Mollan SP, Logeswaran A, Sinclair AB, Wakerley BR. Current Perspective on Retinal Migraine. Vision (Basel) 2021; 5:38. [PMID: 34449754 PMCID: PMC8396291 DOI: 10.3390/vision5030038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
Retinal migraine was first formally described in 1882. Various terms such as "ocular migraine" and "ophthalmic migraine" have since been used interchangeably in the literature. The lack of a consistent consensus-based definition has led to controversy and potential confusion for clinicians and patients. Retinal migraine as defined by the International Classification of Headache Disorders (ICHD) has been found to be rare. The latest ICHD defined retinal migraine as 'repeated attacks of monocular visual disturbance, including scintillation, scotoma or blindness, associated with migraine headache', which are fully reversible. Retinal migraine should be considered a diagnosis of exclusion, which requires other causes of transient monocular visual loss to be excluded. The aim of this narrative review is to summarize the literature on retinal migraine, including: epidemiology and risk factors; proposed aetiology; clinical presentation; and management strategies. It is potentially a misnomer as its proposed aetiology is different from our current understanding of the mechanism of migraine.
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Affiliation(s)
- Yu Jeat Chong
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK; (Y.J.C.); (S.P.M.)
| | - Susan P. Mollan
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK; (Y.J.C.); (S.P.M.)
| | | | - Alexandra B. Sinclair
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
- Metabolic Neurology Group, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Benjamin R. Wakerley
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
- Metabolic Neurology Group, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Maher ME, Kingston W. Retinal Migraine: Evaluation and Management. Curr Neurol Neurosci Rep 2021; 21:35. [PMID: 33973068 DOI: 10.1007/s11910-021-01122-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review aims to summarize the last 15 years of literature and case reports detailing retinal migraine-an uncommon and somewhat poorly understood migraine variant. RECENT FINDINGS In the last 15 years, only 12 cases of retinal migraine have been outlined. Similar to other migraine statistics, retinal migraine appears to affect women more so than men and presents with unilateral headache which tends to be ipsilateral to the side of vision loss. The pathophysiology may relate to vasoconstriction of retinal vessels, as evidenced by ictal fundus photography in the past few years. Retinal migraine is a rare entity, with a paucity of described cases in the literature. Retinal migraine is a diagnosis of exclusion, as monocular vision loss might be ascribed to several concerning disorders requiring urgent diagnosis and treatment, and any patient presenting as such should be thoroughly investigated. Patients suffering from retinal migraine appear to respond to typical migraine abortive therapies including NSAIDs and migraine prophylactic medications.
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Affiliation(s)
- Monica E Maher
- Division of Neurology, University of Toronto, Toronto, Canada
| | - William Kingston
- Division of Neurology, University of Toronto, Toronto, Canada. .,Sunnybrook Health Sciences Centre, A 455 - 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. .,Centre for Headache, Women's College Hospital, Toronto, Canada.
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Hadjikhani N, Vincent M. Visual Perception in Migraine: A Narrative Review. Vision (Basel) 2021; 5:20. [PMID: 33924855 PMCID: PMC8167726 DOI: 10.3390/vision5020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Migraine, the most frequent neurological ailment, affects visual processing during and between attacks. Most visual disturbances associated with migraine can be explained by increased neural hyperexcitability, as suggested by clinical, physiological and neuroimaging evidence. Here, we review how simple (e.g., patterns, color) visual functions can be affected in patients with migraine, describe the different complex manifestations of the so-called Alice in Wonderland Syndrome, and discuss how visual stimuli can trigger migraine attacks. We also reinforce the importance of a thorough, proactive examination of visual function in people with migraine.
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Affiliation(s)
- Nouchine Hadjikhani
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, 41119 Gothenburg, Sweden
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Abstract
Transient disturbances in neurologic function are disturbing features of migraine attacks. Aura types include binocular visual, hemi-sensory, language and unilateral motor symptoms. Because of the gradual spreading quality of visual and sensory symptoms, they were thought to arise from the cerebral cortex. Motor symptoms previously included as a type of migraine aura were reclassified as a component of hemiplegic migraine. ICHD-3 criteria of the International Headache Society, added brainstem aura and retinal aura as separate subtypes. The susceptibility to all types of aura is likely to be included by complex and perhaps epigenetic factors.
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Affiliation(s)
- Rod Foroozan
- Baylor College of Medicine, 6565 Fannin NC-205, Houston, TX 77030, USA.
| | - F Michael Cutrer
- Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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