Vertebral Artery Dissection Presenting as a Migrainous Visual Aura after Sexual Activity: A Case Report

Migrainous visual aura is characterized by gradual, fully reversible positive visual phenomena often followed by headache. However, vascular conditions such as vertebral artery dissection (VAD) may closely mimic migraine aura, particularly when atypical features are present.

A 30-year-old previously healthy woman presented with two episodes of unilateral peripheral blurry vision with shimmering phenomena occurring minutes after sexual activity, followed by migrainous headache. She had no prior migraine history, and neurological and ophthalmologic examinations were normal. Given the side-locked symptoms and exertional trigger, vascular imaging was performed. Computed tomography angiography demonstrated severe stenosis of the left vertebral artery at the V1-V2 junction consistent with dissection, confirmed on magnetic resonance angiography. No acute infarction was identified. She was treated with dual antiplatelet therapy and remained asymptomatic at follow-up.

VAD may present with isolated positive visual disturbances mimicking migraine aura, even in young patients without vascular risk factors. Atypical features such as first-time aura and exertional onset should prompt consideration of vascular imaging to avoid misdiagnosis.