Headache as an initial manifestation of Vogt–Koyanagi–Harada disease

Abstract

A 29 year-old healthy Saudi female presented with a 1 week history of headache followed by decreased vision in both eyes. Biomicroscopy revealed anterior uveitis without hypopyon, posterior synechia or keratic precipitate. Fundus examinations were remarkable for serous retinal detachment and hyperemic discs. Fundus fluorescein angiogram showed a hot disc with multiple pinpoint leakage in both eyes. CT scan and MRI were normal, all uveitis workups were negative. Five months later, the patient presented with complete criteria of Vogt-Koyanagi-Harada disease including a 2 weeks history of tinnitus, alopecia, poliosis and vitiligo. Headache alone followed by decreased vision before the onset of neurological and auditory symptoms can be an initial presentation of VKH disease. VKH should be considered in the differential diagnosis of atypical presentation of symptoms.

Reappraisal of the management of Vogt–Koyanagi–Harada disease: sunset glow fundus is no more a fatality

“…At the start of disease, patients may complain of headaches (a precious diagnostic element very often present), nausea, vertigo, fever, meningismus scalp hypersensitivity and orbital pain [ 12 , 13 ]. This first, prodromal stage of disease is usually lasting for a few days/weeks and corresponds at the ocular level to subclinical inflammation starting exclusively in the choroidal stroma, without any other ocular clinical sign to indicate the presence of the inflammatory process, which can only be identified at this stage by performing indocyanine green angiography (ICGA) [ 14 ].…”

Initial misdiagnosis of Vogt-Koyanagi-Harada disease

“…Tugal-Tutkun et al found that headache was the most frequent symptom in their series which occurred in 69% patients 4 . However, headache alone does not fulfill the diagnostic criteria and is insufficient for the diagnosis of VKH disease 1, 5. On the other hand, optic disc hyperemia or swelling is a common finding in patients with VKH disease 6, 7.…”

“…Ohno et al found that optic disc swelling was found in 87% of their patients at presentation 7 . VKH disease classically has four clinical phases including prodromal; acute uveitic; chronic convalescent; and chronic recurrent stage 5 . The prodromal phase usually lasts few days and patients typically complain of neurological and auditory symptoms.…”

“… 4 However, headache alone does not fulfill the diagnostic criteria and is insufficient for the diagnosis of VKH disease. 1 , 5 On the other hand, optic disc hyperemia or swelling is a common finding in patients with VKH disease. 6 , 7 Ohno et al found that optic disc swelling was found in 87% of their patients at presentation.…”

Vogt-Koyanagi-Harada Disease and Birdshot Retinochoroidopathy, Similarities and Differences: A Glimpse into the Clinicopathology of Stromal Choroiditis, a Perspective and a Review

“…At the start of the disease, patients may complain of headaches (a precious diagnostic element very often present), nausea, fever, meningismus, and orbital pain. Sometimes patients complain of flu-like symptoms, scalp and skin tenderness as well as cochlearvestibular signs (tinnitus, hearing loss, vertigo) [39,40]. This prodromal stage usually lasts for a few days.…”