Differential Diagnosis of Visual Phenomena Associated with Migraine: Spotlight on Aura and Visual Snow Syndrome

Barral, Eliseo; Silva, Elisa Martins; García‐Azorín, David; Viana, Michele; Puledda, Francesca

doi:10.3390/diagnostics13020252

Cited by 8 publications

(17 citation statements)

References 83 publications

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“…Some patients refer to the visual symptoms as zigzags, bubbles, or clouds. In this self-described dynamic visual phenomenon, the small flickering dots can be mostly black and white (grey on a black background or black and grey on a white background), but they can also be transparent or coloured [ 22 , 34 , 37 , 47 , 48 ]. The first description in the literature comes from 1995 [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most common symptom of migraine aura is visual aura. It is present in 98–99% of aura cases [ 34 ]. These data highlight the need to include both optic snow syndrome and visual aura in the differential diagnosis of transient visual disturbances.…”

Section: Introductionmentioning

confidence: 99%

“…However, patients with missed stroke are most often initially misdiagnosed as having migraine. In particular, transient ischaemic attacks can be difficult to exclude in patients whose aura is abrupt or of unusual duration [ 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Visual Snow Syndrome in Patient with Migraine: Case Report and Literature Review

Chojdak-Łukasiewicz,

Dziadkowiak

2024

JCM

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Visual snow syndrome (VSS) is a rarely diagnosed neurological phenomenon. It is a visual disorder characterised by the presence of numerous white, black, or translucent dots in the visual field, resembling the ‘snow’ of an analogue TV set experiencing reception interference. According to The International Classification of Headache Disorders, 3rd edition, visual snow is defined as a pattern of continuous small dots across the visual field lasting >3 months and accompanied by at least two of the following four additional symptoms: palinopsia, increased entoptic phenomena, photophobia, and nyctalopia. These complaints are not consistent with a typical migraine with visual aura and cannot be better explained by another disorder. The authors present the case of a 39-year-old woman who was diagnosed with VSS. The symptoms appeared after a migraine attack and had not alleviated. The patient reported a sensation of constant ‘TV screen snow’. A neurological examination found no signs of focal damage to the nervous system. The results of the ophthalmological examination, MRI of the brain with contrast, MRI of the eye sockets, and EEG were normal. VSS is a phenomenon that is still not fully understood, different from migraine aura and associated with a number of additional symptoms. VSS is very difficult to treat. In this case, a lot of drugs were used without improvement. Further research must be conducted to determine the best treatment options for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Visual Snow Syndrome in Patient with Migraine: Case Report and Literature Review

Chojdak-Łukasiewicz,

Dziadkowiak

2024

JCM

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“…The role of the cerebral cortex in migraine was initially linked to the aura phenomenon and its peculiar symptoms [ 80 , 81 ]. Aura is thought to be generated by cortical spreading depression (CSD) [ 82 ], which has been indirectly evidenced in humans through functional neuroimaging [ 83 ].…”

Section: Migraine: Functional Anatomy and Pathophysiologymentioning

confidence: 99%

Migraine: from pathophysiology to treatment

et al. 2023

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Migraine is an extremely disabling, common neurological disorder characterized by a complex neurobiology, involving a series of central and peripheral nervous system areas and networks. A growing increase in the understanding of migraine pathophysiology in recent years has facilitated translation of that knowledge into novel treatments, which are currently becoming available to patients in many parts of the world and are substantially changing the clinical approach to the disease. In the first part of this review, we will provide an up to date overview of migraine pathophysiology by analyzing the anatomy and function of the main regions involved in the disease, focusing on how these give rise to the plethora of symptoms characterizing the attacks and overall disease. The second part of the paper will discuss the novel therapeutic agents that have emerged for the treatment of migraine, including molecules targeting calcitonin gene-related peptide (gepants and monoclonal antibodies), serotonin 5-HT1F receptor agonists (ditans) and non-invasive neuromodulation, as well as providing a brief overview of new evidence for classic migraine treatments.

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“…Migraine photophobia seems to be mediated by alterations in the retino-thalamo-cortical pathway [40] and has also been linked to visual cortex hyperexcitability [41]. In a study investigating migrainous photophobia using H (2) (15) O PET, it was revealed that an area of the extrastriate visual cortex mostly involving the lingual gyrus (LG) shows increased activation during light stimulation in patients [42]. This same brain area, involved in relevant physiological functions such as visual memory, has found to be abnormally active in VSS as well [36].…”

Section: Migraine and Vssmentioning

confidence: 99%

Visual snow syndrome and migraine: a review

Silva

Puledda

2023

Eye

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Visual snow syndrome is a neurological condition characterized by ongoing prominent phenomena described consistently as tiny dots moving across the entire visual field, often associated with complex visual symptoms. These can take the form of afterimages, entoptic phenomena, nyctalopia and light sensitivity. Although some of these symptoms can be benign, they can nonetheless become significantly impactful for many who experience them, particularly in cases that have a sudden and abrupt start. As visual snow syndrome becomes increasingly recognized in clinical practice we begin to learn about its typical presentation and underlying pathophysiology. Treatment of visual snow, however, still proves quite challenging, and efforts need to be focused on unravelling the biological mechanisms of the syndrome. This endeavour has characterized the most recent research on visual snow, mostly involving neuroimaging, neurophysiological and neurobehavioral studies aimed at understanding its underlying neural signature. Another important aspect of the syndrome, which will likely prove critical in deepening our understanding of visual snow, is represented by the intricate biological and historical connexion with migraine. This narrative review focused on visual snow syndrome will explore its clinical, pathophysiological and treatment aspects in detail.

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Differential Diagnosis of Visual Phenomena Associated with Migraine: Spotlight on Aura and Visual Snow Syndrome

Cited by 8 publications

References 83 publications

Visual Snow Syndrome in Patient with Migraine: Case Report and Literature Review

Visual Snow Syndrome in Patient with Migraine: Case Report and Literature Review

Migraine: from pathophysiology to treatment

Visual snow syndrome and migraine: a review

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