Scintillating Scotoma?

[FlyingOfficerKite]

A colleague of mine described an experience he hadn't had before whilst we were having lunch yesterday.

He is 25 years old and considered he had suffered his first Ocular Migraine.

I explored Wikipedia and wondered if the visual symptoms he presented might have been that of a Scintillating Scotoma?

The questions I ask are;



Should he visit his GP;
Is it likely to be 'lifestyle induced' (he drinks moderately, likes a take-away (doesn't smoke) but has recently taken up regular, demanding physical exercise with a local gym);
Consider it might be an indication of an underlying medical condition?

Or all three?

Otherwise he is (as far as I am aware) perfectly healthy.

Kind regards

FOK :)

[homonculus]

Apart from the fact that he was eating I am struggling with the lack of symptoms.

If he thinks he is unwell I would recommend he visits his doctor

[Loose rivets]

If it was migraine with aura, then can we know a little more about the symptoms. In particular, if it was a scintillating pattern with a distinctive sawtooth series of white lines.

Vital to know if it was in both eyes and if there was a headache afterwards.

There is an odd thing that occurs in some people where they get a flash every time they blink. There is a disturbed area left behind which impairs vision slightly. THIS IS IN ONE EYE ONLY. It also often follows eating sharp/sour fruit. There is no headache. I doubt this has anything to do with migraine, but I'm not sure.


The thing about having migraine diagnosed, is that it marks one's medical records for ever. But risk missing a brain tumor? Tough call.

I'm as convinced as anyone can be that chocolate is a trigger for migraine. Say, 90% certain. The prime cause I still think is deep seated worry - anything else being a trigger.

[FlyingOfficerKite]

Thank you for your replies.

Like you visiting his GP is a must - I hope it is lifestyle related and not the symptom of some other underlying problem?

Kind regards

FOK :)

[FlyingOfficerKite]

Seems it was in one eye only.

He complains he is always fatigued - although he goes to the gym (Cross Fit) every other day.

I must say that I had lunch with him today and he looked off colour (dark rings around his eyes and not his usual self).

He is going out on the binge tomorrow and not looking forward to it which is strange for him?!

FOK

[twinjetter]

Nasty little blighters, these things.

I've been getting them on and off for ten years. No apparent pattern, although I go through a phase of having them up every couple of days/daily for a week or two, then no more for three/six months or more.

They are quite debilitating when they come along; although cause no direct pain. I certainly wouldnn't be able to drive when one is in full flow. Start off as a pinprick of blurring and then grow slowly with the sawtooth pertimer as Rivets describes. Eventually you can see clearly through the middle of it, but can see nothing at the point where the sawtooth marks are. Tend to last up to 30 mins, and eventually just disappear outside of peripheral vision.

I'm not convinces that they are in the eye; they feel more likely to be somewhere behind where your brain processes info - I usually have a single blur that grows over both eyes vision and remains in the same location if I close each eye in turn. Does normally start in my dominant eye though.

Doc has in the past said that causal effects can be fatigue, stress factors and dehydration/caffeine abuse...I plead guilty to all the above! Whilst I'm not qualified to offer ANY medical advise, I have in the past been able to kill them off as soon as I feel the first symptom with 3 x paracetamol and 2 pt's water double-quick (I'm not normally a big fan of pill-popping)

Could even be something pyschosematic in them too...saw this post yesterday and meant to reply; then hey-presto I find myself writing this through the middle of an episode!! Months since my last one - all very strange.

Also as Rivets mentioned, it could be deep-seated worry (sub-conscoius) - I lost my job last week, and whilst I'm quite chilled and optimistic; who know what lurks beneath....

[FlyingOfficerKite]

twinjetter

Thank's very much for your reply.

If the subject is raised again I'll mention all you have said.

I don't want to cause any alarm for him, but he has got some stresses in his life (work, qualifications, health of his father), so maybe that could be a causal effect.

Your method of killing them off is useful info, so I'll mention that too.

Kind regards

FOK :)

[gingernut]

Wow! What exactly were his symptoms ?

Usual advice-consult the AME. But it'll likely get him grounded until further investigations.

Difficult to give advice via the internet without actively listening to the paient.

Of course, if he wasn't a pilot, and it was a "one off" it's quite reasonable to adopt a "wait and see" approach, to what sounds like a migranous condition.

Usual triggers include red wine, blue cheese, nicotine, nescafe, hot curry sauce and the days before a period.

[Aeronought]

This is close to what I experienced recently and I'm sorry to say was diagnosed as a TIA (otherwise called a mini-stroke). Obviously there is danger here for anyone controlling machinery and anyone so diagnosed is, I believe, forbidden to drive for a period of one month after the incident without repetition of symptoms.
To my knowledge it is important to get medical opinion within 24 hours.

[riverfish]

Obviously not seen the person, or quizzed them, but this has all the hallmarks of a scintillating scotoma, which is typical of ocular migraine.

At 26 it is highly unlikely to be a tia. On what basis was the last poster labelled as this. ...I presume they have had a scan with positive findings (which most tia's will not have) or there are other aspects that the last poster has not made clear.Otherwise it is a life changing diagnosis for someone in your business.

Also the story does not fit with a brain tumour, so highly unlikely ...the symptoms would be more persistent and progressive, with other things.


It sounds like the ocular migrains I used to have. Zigzags are typical of migranous aura, but they can be twinkling shimmering areas of distortion too.

You can also get visual distortion.... eg. like looking through a telescope the wrong way.....not ideal if you are about to land a plane!!!!

Has he ever suffered from headaches particularly with nausea or vomiting?


triggers are as mentioned, but the biggest one is tiredness or stress/pressure. Or to be more exact when the pressure is easing.
so If you have had a busy and overtiring period on the roster, it happens on your day off!!!

Sleep will ease it, and in my experience, and that of other migraine sufferers you get a period of dreamy rem sleep that often makes a migraine go.


Most sufferers of migraine will be diagnosed on history and not on investigations like scans. Basic exam like bloodpressure and cranial nerves will presumably have been done for the periodic licence medicals.


It may come periodically, but some people get one attack, never to be repeated, or not repeated for many years.

[twinjetter]

FOKite

My pleasure, but I just want to re-iterate that the paracetamol and copious quantities of water is something that has on occasion worked for me (not all of the time). I wouldn't dare to call it a cure; just a sticking plaster that sometimes sticks for me:)

Thinking about it, riverfish might be on to something with the idea of occurrences being when pressure/stress is receeding. Most of my episodes have been at home (where I should be relaxed) and certainly I can think of events on blocks of days off after night duty.

I've started a log of occurrences (thankfully only the one so far) as a result of this thread, so thanks from me too for everyone's input.

TWJ