[Localized neural loss detected by macular thickness reduction using optical coherence tomography: case report]

Area of Science:

• Ophthalmology
• Neurology
• Medical Imaging

Background:

• Migraine headaches with aura are common, but visual disturbances can be complex.
• Central scotoma and headache episodes warrant thorough investigation for underlying causes.
• Retinal migraine is a potential diagnosis for visual disturbances associated with migraine.

Observation:

• A 22-year-old male presented with a 6-month history of central scotoma in the left eye and severe headaches.
• Ophthalmic examination revealed reduced retinal nerve fiber layer thickness in the left papilomacular bundle.
• Optical coherence tomography (OCT) showed significant macular thickness reduction and localized retinal nerve fiber layer loss.

Findings:

• Systemic, neuroimaging, and cardiovascular evaluations were inconclusive.
• The visual loss was potentially attributed to retinal migraine, though other ischemic events were considered.
• OCT demonstrated localized neural loss via macular thickness measurements, in addition to peripapillary retinal nerve fiber layer assessment.

Implications:

• This case underscores the utility of OCT in identifying subtle, localized neural deficits.
• Macular thickness measurements by OCT can serve as a valuable diagnostic tool for visual pathway abnormalities.
• Further research into OCT's role in diagnosing and monitoring retinal migraine and other optic neuropathies is warranted.