Permanent damage of the inner retinal layers in a patient with migraine: a different case of paracentral acute middle maculopathy

Lucas, C.E. Monera; Serrano, J. Escolano; Valero, D. Romero; Martínez, G Castilla; López, S Pardo; Martos, R. Toledano

doi:10.1016/j.oftale.2022.10.001

Cited by 2 publications

(5 citation statements)

References 10 publications

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“…The sudden emergence of a central scotoma alongside a history of migraines is a notable indication for evaluation of potential acute retinal ischemia. The spectrum of retinal ischemia may range from PAMM to branch and central retinal artery occlusions [ 2 , 5 ]. This is evidenced by the overlapping risk factors associated with PAMM, RAOs and even cerebral infarction: hypertension, cigarette smoking, cardiac disease, diabetes, obesity, and, relevant to our patient, migraines, dyslipidemia, and female sex [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Evaluation of the retinal ischemic vision loss was done through OCT, an indispensable tool allowing accurate diagnosis of PAMM and other vascular abnormalities [ 2 ]. En face OCT allows the identification of three distinct patterns of ischemia in PAMM: arteriolar, globular, and fern-like [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…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 ]. PAMM has also been associated with systemic conditions such as hypotension, dyslipidemia, pregnancy, migraines, and use of vasopressors [ 1 , 2 ]. 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 ].…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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 Associated With Migraine With Aura in Pregnancy

De Silva,

Da Costa

2024

Cureus

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Paracentral acute middle maculopathy (PAMM) is a form of ischaemic maculopathy involving infarction of the inner nuclear layer secondary to deep retinal capillary plexus ischaemia. Risk factors include retinal vascular disease and systemic vascular risk factors, which can predispose the eye to ischaemia. Recent reports now show associations with pregnancy and also migraine episodes. We report an interesting case of a young patient developing PAMM following a migraine with an aura episode during an uncomplicated pregnancy.

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Permanent damage of the inner retinal layers in a patient with migraine: a different case of paracentral acute middle maculopathy

Cited by 2 publications

References 10 publications

Paracentral Acute Middle Maculopathy in Migraines with Aura

Paracentral Acute Middle Maculopathy in Migraines with Aura

Paracentral Acute Middle Maculopathy Associated With Migraine With Aura in Pregnancy

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