![]() It commences from the side (lateral aspect of the visual field) and ‘marches’ inwards. Kaleidoscopic hallucination as this can affect either one or both eyes, but usually unequally. This is often a short-lived distortion of image and as in our patient, only lasted a few minutes. Others have described it as “dancing grains of light”. The brain creates the visual hallucination of ‘fractured’ or bright lights similar to the image when looking through a kaleidoscope. This usually is seen in the peripheral vision as wavy images or even dazzling fragments. Kaleidoscopic hallucinations are thought to originate in the prestriate area of the brain whilst the zigzag patterns of teichopsia is generated in the striate cortex. Visual aura usually last between 10-30 minutes. ![]() If the aura lasted more than 60 minutes, it would be classified as a persistent aura without infarction. The duration of her aura lasted less than an hour, which is the usual. These visual symptoms are fully reversible. ![]() The gradual spread that she described is one of the more typical feature of a migraine aura. Such patients can still have a migraine attack without aura as well. The patient’s visual symptoms with flickering, bright and multi-colored waves of lights appear to fit into the description of a ‘fortification spectrum’ that usually expands in a C-shape over one side (lateral aspect) of the visual field, only in her left eye, thus far. Our patient would be classified as having migraine with aura. An EEG (electroencephalography) done was also normal.Ī final diagnosis of Migraine with Visual Aura was made. The CT scan and Magnetic Resonance Imaging (MRI) of the brain (done after the attack) were also normal. Her ESR (erythrocyte sedimentation rate), protein S, protein C, anti-thrombin III factor and antiphospholipid antibody were all normal. Her blood investigations, full blood count, electrolytes, renal function, thyroid function test, liver function test and calcium-magnesium-phosphate were all normal. The only significant family history is her mum who has a history of migraine, without any visual aura.Īt presentation, the examination of the patient was completely normal: stable vital signs, no fever, no localizing cranial nerves or neurological signs. For her migraine, she takes a combination of paracetamol, diclofenac and prochloperazine as needed. The patient has never been on any regular drugs nor medications. Also, the attack has only happened in her left eye and never in the right eye, thus far. There were no sensory or motor disturbances associated with these attacks. There was one occasion when she developed vertiginous giddiness after the visual aura symptom. The headache may last anything between 30 minutes to several hours. By the time the headache comes on, the visual symptoms would have subsided. The visual symptom started first and is followed by the headache. Each episode would last about 15-20 minutes. She has observed this only in the last 6 months, with the attack coming on about once a month. There were no associated scotomas or sudden blindness and she was still able to identify normal images whilst experiencing the attack. At the same time, she noticed wave-like, flickering movements comprising of variety of colors (red, blue, green and yellow), commencing laterally and slowly spreading to the superior part of the visual field in her left eye. She described this as an appearance she had seen through a ‘kaleidoscope’. There was narrowing of the visual field in her left eye, whereby the area affected was the outer and lateral part of the visual field. A 54 year old lady with a history of migraine for many years (where she only has headaches), presented with new onset visual symptom.
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