Recurrent Branch Retinal Infarcts in Association With Migraine

Abstract

Migraine has been blamed for a variety of temporary and permanent visual complications. We describe the case of a young woman with migraine who suffered recurrent episodes of retinal infarction, one of which occurred during an attack of migraine. The infarctions resulted from occlusions of branches of the central retinal artery Extensive laboratory and radiological investigations failed to establish a nonmigrainous etiology. In some individuals, migraine may cause or promote branch retinal vaso-occlusion and infarction. Isolated instances of central retinal artery occlusion (CRAO), 1 cilioretinal artery occlusion (CAO), 2,3 branch retinal artery occlusion (BRAO), 4,5 and anterior ischemic optic neuropathy (AION) 6 have been reported in association with migraine. Such cases are rare despite the high prevalence of migraine in the population Instances of transient monocular scotomas on even blindness are more commonly encountered in individuals with migraine and are more apt to accompany or immediately precede the headache. These transient attacks may represent the effects of reversible retinal ischemia. The patient described in this report has a history of migraine and had two episodes of retinal infarction. One of these occurred with an episode of migraine. CASE HISTORYAn otherwise healthy 22-year-old woman, whose maternal grandmother had migraine, began to have severe, right-sided headaches preceded by blurring in the periphery of her left visual field. These headaches were throbbing and were associated with nausea, photophobia, and phonophobia. Her neurological examination was normal, and an enhanced computerized tomographic (CT) scan of the brain showed no abnormalities. She subsequently had episodes of visual scintillations lasting up to 30 minutes, both with and without headache. During some of these episodes, she had numbness and tingling in her left hand and arm.At age 24, white headache-free, she noticed a defect in the upper nasal quadrant of the visual field of her left eye. The general physical and neurological examination disclosed no abnormalities. Visual acuity was normal. Funduscopic examination revealed a prominent cloudy swelling of the inferotemporal retina in a nerve fiber layer pattern unassociated with intraretinal hemorrhage and consistent with BRAO. The foveal avascular zone was not involved, and contact lens evaluation of the retinal vasculature showed no evidence of emboli or arteriolar narrowing. There was no venous beading. Fluorescein angiography showed occlusion of an inferior temporal branch of the central retinal artery of the left eye. No emboli or cytoid bodies were seen.Investigations which included echocardiography, chest x-ray, electrocardiography, complete blood counts, antinuclear antibody fiter, erythrocyte sedimentation rate, prothrombin time, partial thromboplastin time, protein S and C, antithrombin III, syphilis screening tests, anticardiolipin antibody levels, beta-human chorionic gonadotropin, blood glucose, serum

Retinal Nerve Fibre Layer Thickness of Migraine Patients with or without White Matter Lesions

“…Glenn et al 31 reported a case of complicated migraine due to bilateral retinal infarction. Beversdof et al 32 reported recurrent branch retinal infarcts in association with migraine. On the other hand, the reported prevalence of cerebral WML in migraineurs ranges from 4% to 59% in selected studies.…”

Retinal Nerve Fibre Layer Thickness in Migraine Patients with or without Aura

“…10,11 Retinal alterations described in the literature manifest as acute and chronic retinal damage. Migraine can lead to focal decrease in cerebral blood flow and perhaps in retinal circulation.…”

“…[10][11][12] Using colour Doppler imaging, Kara et al 13 reported that central retinal artery and posterior ciliary artery vessel resistance was higher in patients with migraine in both headache and headache-free periods compared with the control group. All of these studies support the hypothesis of low perfusion and vascular retinal variations in migraine.…”

Retinal Vascular Occlusions

“…It could be recurrent (Barak et al, 1997;Beiran et al, 1995;Beversdorf et al, 1997;Johnson et al, 1994). Most of these cases probably have Susac's syndrome (autoimmune endotheliopathy leading to encephalopathy, BRAO and hearing loss) (Susac et al, 2007).…”