Effects of visual pathway lesions on the visual aura of migraine |
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Authors: | FE Lepore |
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Institution: | Departments of Neurology and Ophthalmology, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ, USA |
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Abstract: | The aim was to to determine if the visual aura of migraine is altered by disease of the afferent visual pathways and if visual aura changes are associated with pre- or postgeniculate lesions. Functional neuroimaging during migraine demonstrates primary visual/extrastriate cortex as an anatomical substrate of visual aura. Neuro-ophthalmological records (including kinetic and static perimetry) of 25 patients with visual loss and typical aura with or without migraine headache were reviewed. Twenty-five patients (16 women, nine men) (mean age 59.8 years) with typical aura had visual loss from pregeniculate (72%) or postgeniculate lesions (28%). Eight patients (four postgeniculate cerebrovascular accidents or arteriovenous malformations, two lifelong optic neuropathy/retinopathy, one childhood ocular trauma, one anisometropic amblyopia) reported absence or alteration of visual aura. Postgeniculate lesions were significantly associated ( P = 0.017) with visual aura changes. The association of postgeniculate lesions with altered auras points to a postgeniculate effect on aura appearance (consistent with functional neuroimaging findings). Although statistically significant, this series' association of postgeniculate disease and aura changes is even more robust ( P = 0.0002) when structural changes of ocular dominance columns are posited in three patients with optic neuropathy, retinopathy and keratopathy of congenital or childhood origin. |
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Keywords: | Migraine aura postgeniculate disease Charles Bonnet syndrome |
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