Scintillating scotoma is the most common visual aura preceding migraine and was first described by 19th century physician Hubert Airy (1838–1903).

Presentation

It may occur as an isolated symptom without headache in acephalgic migraine. Although many variations occur, scintillating scotoma usually begins as a spot of flickering light in the center of the visual fields, which to some degree obscures the field of view. The scotoma then expands into one or more shimmering arcs of white or colored flashing lights. An arc of light may gradually enlarge, become more obvious, and may take the form of a definite zig-zag pattern, sometimes called a fortification spectrum, because of its resemblance to the battlements of a castle or fort seen from above. It may be bilateral or unilateral.

It may be difficult to read and dangerous to drive a vehicle while the scotoma is present. Normal central vision may return several minutes before the scotoma disappears from the peripheral vision.

Prognosis

Symptoms typically resolve within 15-30 minutes, leading to the headache in classic migraine, or resolving without consequence in acephalgic migraine.

See also

• Cortical spreading depression
• Scotoma

External links

• AgingEye Times
• Imigraine.Net - includes images of scintillating scotomata

References

• Gardner-Medwin AR (1981). "Possible roles of vertebrate neuroglia in potassium dynamics, spreading depression and migraine". J. Exp. Biol. 95 111–27.
• Hadjikhani N, Sanchez Del Rio M, Wu O, et al (2001). "Mechanisms of migraine aura revealed by functional MRI in human visual cortex". Proc. Natl. Acad. Sci. U.S.A. 98 (8): 4687–92.