Migraine-Like Positive Visual Phenomena Related to Focal Cortical Lesions with Undetectable Visual Field Defects

Area of Science:

• Neurology
• Ophthalmology

Background:

• Migraines are frequently accompanied by visual aura, a common neurological symptom.
• Cortical lesions near visual pathways can mimic migraine aura but may not cause visual field defects.

Observation:

• Four patients presented with visual disturbances resembling migraine aura.
• Causes included meningioma, cavernoma, occipital lobe infarction, and demyelination (multiple sclerosis).
• These lesions were often subtle, not detected by standard visual field testing.

Findings:

• Patients experienced transient positive visual phenomena.
• No neurosurgical intervention was required for any patient.
• One patient with an occipital lobe infarct had complete symptom resolution.

Implications:

• Highlights the importance of detailed patient history for diagnosing transient visual phenomena.
• Identifies critical neurological pathologies that can present without overt visual field defects.
• Suggests specific clinical features (e.g., age >40, atypical duration, absence of headache) warrant further investigation beyond migraine diagnosis.