Paracentral Acute Middle Maculopathy in a Patient With Frequent Migraine With Aura: A Case Report

Dasari, Vijaya R.; Selliyan, Ananth; Gratton, Sean

doi:10.1097/icb.0000000000001039

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…This includes sickle cell disease [20,21]; giant-cell arteritis [22,23]; embolic events, including those after filler injections [24,25]; and different ocular procedures, such as vitrectomy [26]. Other sporadic factors include migraine [27], viral infections [28], and COVID-19 [29]. However, in young patients, symptomatic PAMM often has no established etiology.…”

Section: Discussionmentioning

confidence: 99%

Small Paracentral Acute Middle Maculopathy Lesions as Biomarker of Vascular Morbidity: Natural Course

Maltsev,

Kulikov,

Burnasheva

et al. 2024

JVD

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Background: To evaluate the incidence rate of small paracentral acute middle maculopathy (PAMM) lesions in healthy fellow eyes of patients with retinal vein occlusions (RVO). Methods: Patients with unilateral branch RVO or central RVO who were followed up for at least one year were included. Fellow healthy eyes were examined with 6 mm optical coherence tomography angiography scans at baseline and at the end of the follow-up. Small resolved PAMM lesions were displayed using structural en face projections of the slab between two segmentation lines of the outer plexiform layer with 0 µm and −9 µm offset. New lesions were identified by overlaying baseline and final structural en face projections. Results: A total of 41 eyes of 41 patients (12 females and 29 males, mean age 63.5 ± 10.1 years) were included. The mean follow-up was 23.6 ± 11.4 months. Among all RVO patients, small resolved PAMM lesions in healthy fellow eyes were found in 39 patients (95.1%). In the whole cohort, the median number of PAMM lesions was 5.5 (95% CI 3.0 to 8.0) (mean 6.5 ± 5.7) at baseline, which increased statistically significantly to 5.5 (95% CI 3.8 to 8.2) (mean 6.7 ± 5.7) at the end of the follow-up period (p = 0.03). Eight (19.5%) patients demonstrated new lesions, with a median number of new lesions of 1 (ranged 1 to 2). Conclusions: Small PAMM lesions seem to be a slowly progressing retinal vascular biomarker.

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Section: Discussionmentioning

confidence: 99%

Small Paracentral Acute Middle Maculopathy Lesions as Biomarker of Vascular Morbidity: Natural Course

Maltsev,

Kulikov,

Burnasheva

et al. 2024

JVD

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“…Thus, clinicians can consider PAMM a precursor to RAOs. Notably, migraines with aura are associated with an increased RAO risk compared to migraines without aura, and thus, urgent neurovascular evaluation should be considered [ 3 ]. Since our patient’s symptoms extended far beyond the therapeutic period for an acute stroke, urgent referral to a stroke center was deemed unnecessary.…”

Section: Discussionmentioning

confidence: 99%

“…Being aware of such risk factors alongside compatible visual symptoms, such as acute-onset scotomas, is key to identifying PAMM and managing underlying diseases [ 1 ]. PAMM has recently been described following episodes of migraine [ 2 , 3 ]. In this report, we present a case of PAMM in a healthy woman and describe the role of en face OCT.…”

Section: Introductionmentioning

confidence: 99%

“…Paracentral acute middle maculopathy (PAMM) is an optical coherence tomography (OCT) presentation consisting of hyperreflective bands within the middle retina in patients with deep retinal capillary ischemia involving the inner nuclear layer (INL) [1][2][3][4]. PAMM has been associated with various retinal vascular diseases like central and branch retinal artery occlusions, sickle cell retinopathy, hypertensive retinopathy, and diabetic retinopathy [1,4].…”

Section: Introductionmentioning

confidence: 99%

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Paracentral Acute Middle Maculopathy in Migraines with Aura

Milad,

Antaki,

Farah

et al. 2023

Case Rep Ophthalmol

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Paracentral acute middle maculopathy (PAMM) has recently been described following episodes of migraine. In this report, we present a case of PAMM and describe the role of en face optical coherence tomography (OCT). A 75-year-old woman presented with subjective vision loss over a 2-week period in the right eye. She was known for migraines with aura that presented with progressive spreading of positive and negative visual phenomena which usually resolved in under an hour. Her recent migraine episode was “atypical,” as it lasted 3 days. She also experienced a monocular central scotoma with “black spots and jagged, zig-zag edges.” The positive auras resolved spontaneously, whereas the central scotoma persisted. Spectral domain OCT showed an area of perifoveal hyperreflectivity from the inner plexiform to the outer plexiform layers consistent with PAMM. The mid-retina en face OCT and OCT angiography demonstrated an ovoid focal patch of hyperreflectivity with flow interruption, characteristic of globular PAMM. We diagnosed her with migraines with aura and presumed retinal vasospasm, complicated by retinal ischemia in the form of globular PAMM. Acute retinal ischemia, which may require urgent neurovascular workup and giant cell arteritis evaluation, must be considered in patients with migraines alongside persistent visual changes. Diagnosing PAMM requires a high level of suspicion since it can present without significant changes in visual acuity, visual fields, and fundus photographs. With the inclusion of en face OCT in the clinicians’ diagnostic armamentarium, the slightest signs of retinal ischemic changes, such as PAMM, become evident.

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“…Although PAMM and CWS have been independently linked to migraine in the literature, to the best of our knowledge, the three occurring simultaneously have not been described. 7,8 Our patient had a history of migraine headaches with aura in the past. He experienced sparkles in his vision a week before the scotoma.…”

Section: Np40mentioning

confidence: 95%

Paracentral acute middle maculopathy and cotton wool spots in a patient with ocular migraine: A case report

Hall,

Maleki

2024

European Journal of Ophthalmology

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In this study, we report paracentral acute middle maculopathy (PAMM) and cotton wool spots (CWS) in a patient with ocular migraine. A 74-year-old man presented with persistent paracentral scotoma in the right eye that began a week prior. His visual acuity was 20/25 in the right eye and 20/40 in the left. Dilated fundoscopy revealed CWS in the right eye. Spectral-domain optical coherence tomography (SD-OCT) showed hyper-reflective bands in the inner nuclear layer corresponding to parafoveal lesions seen on near-infrared imaging in the right eye consistent with the diagnosis of PAMM. Further laboratory studies were unremarkable, and a transthoracic echocardiogram and a carotid ultrasound were unrevealing. The patient was started on brimonidine three times daily in both eyes. The patient reported subjective improvement in the paracentral scotoma and the absence of ocular migraine symptoms at two-month follow-up. We conclude from this case that PAMM and CWS can occur simultaneously in ocular migraine, and we suggest that retinal vascular changes associated with ocular migraine may contribute to ischemia underlying both entities. Additionally, we suggest a potential therapy in brimonidine due to its proposed beneficial effects on retinal vasculature and neuroprotection.

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Paracentral Acute Middle Maculopathy in a Patient With Frequent Migraine With Aura: A Case Report

Cited by 7 publications

References 9 publications

Small Paracentral Acute Middle Maculopathy Lesions as Biomarker of Vascular Morbidity: Natural Course

Small Paracentral Acute Middle Maculopathy Lesions as Biomarker of Vascular Morbidity: Natural Course

Paracentral Acute Middle Maculopathy in Migraines with Aura

Paracentral acute middle maculopathy and cotton wool spots in a patient with ocular migraine: A case report

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