J Korean Ophthalmol Soc.  2010 Nov;51(11):1537-1542. 10.3341/jkos.2010.51.11.1537.

A Case of Prolonged Bilateral Inferior Altitudinal Visual Field Defect in a Young Migraineur

• Hong JT
• Lim HT

• KMID: 2213993
• DOI: http://doi.org/10.3341/jkos.2010.51.11.1537

Abstract

PURPOSE
To report a case of prolonged bilateral inferior altitudinal visual field defect in a young migraine patient.
CASE SUMMARY
A 13-year-old female patient presented with bilateral disturbance of visual acuity and visual field, which had begun one month before. She complained of headache, with recently increasing frequency, that occurred 3 or 4 days a week for about 2~3 hours duration, sometimes accompanied by nausea and located in the frontotemporal and retrobulbar area. Brain magnetic resonance imaging showed no abnormal finding in the brain and orbit. Her visual acuity was hand motion in both eyes and Humphrey visual field test showed bilateral inferior altitudinal visual field defect. Pupillary resonse was normal and extraocular muscle movement, anterior segment and fundus were also normal in ophthalmologic examination. Her best corrected visual acuity was 1.0 in both eyes by fogging method, but bilateral inferior altitudinal visual field defect persisted for 6 months follow-up.
CONCLUSIONS
Bilateral inferior altitudinal visual field defect can be developed in a migraine patient without other causes. Careful examinations to rule out other causes such as ischemic optic neuropathy or brain infarct should be performed in a migraine patient who complains of visual disturbance.

Keyword

Aura; Migraine; Visual field defect

MeSH Terms

Adolescent
Brain
Epilepsy
Eye
Female
Hand
Headache
Humans
Magnetic Resonance Imaging
Migraine Disorders
Muscles
Nausea
Optic Neuropathy, Ischemic
Orbit
Visual Acuity
Visual Field Tests
Visual Fields
Weather

Figure

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  Figure 1. Fundus photographs showed normal optic disc and fundus in both eyes.

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  Figure 2. (A) Humphrey visual fied test and (B) Goldmann visual field test showed bilateral inferior altitudinal visual field defect respecting the horizontal meridian.

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  Figure 3. Fluorescein angiography did not show any leakage or abnormal finding in optic disc and retina at recirculation phase.

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  Figure 4. Humphrey visual fied test at 6 month follow-up showed persist bilateral inferior altitudinal visual field defect.

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  Figure 5. Brain SPECT images showed diffuse patchy cortical distribution of Tc-99m-ECD (technetium-99m-ethyl cysteinate dimer), in particular significant decrease of cortical perfusion in right temporal (black arrow) and occipital lobe (gray arrow).

Reference

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