Paracentral Acute Middle Maculopathy in Migraines with Aura
Paracentral acute middle maculopathy (PAMM) has recently been described following episodes of migraine. In this report, we present a case of PAMM and describe the role of en face optical coherence tomography (OCT). A 75-year-old woman presented with subjective vision loss over a 2-week period in the...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2023-10-01
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| Series: | Case Reports in Ophthalmology |
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| Online Access: | https://beta.karger.com/Article/FullText/534346 |
| _version_ | 1827630120883453952 |
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| author | Daniel Milad Fares Antaki Andrew Farah Karim Hammamji Marc Saab |
| author_facet | Daniel Milad Fares Antaki Andrew Farah Karim Hammamji Marc Saab |
| author_sort | Daniel Milad |
| collection | DOAJ |
| description | Paracentral acute middle maculopathy (PAMM) has recently been described following episodes of migraine. In this report, we present a case of PAMM and describe the role of en face optical coherence tomography (OCT). A 75-year-old woman presented with subjective vision loss over a 2-week period in the right eye. She was known for migraines with aura that presented with progressive spreading of positive and negative visual phenomena which usually resolved in under an hour. Her recent migraine episode was “atypical,” as it lasted 3 days. She also experienced a monocular central scotoma with “black spots and jagged, zig-zag edges.” The positive auras resolved spontaneously, whereas the central scotoma persisted. Spectral domain OCT showed an area of perifoveal hyperreflectivity from the inner plexiform to the outer plexiform layers consistent with PAMM. The mid-retina en face OCT and OCT angiography demonstrated an ovoid focal patch of hyperreflectivity with flow interruption, characteristic of globular PAMM. We diagnosed her with migraines with aura and presumed retinal vasospasm, complicated by retinal ischemia in the form of globular PAMM. Acute retinal ischemia, which may require urgent neurovascular workup and giant cell arteritis evaluation, must be considered in patients with migraines alongside persistent visual changes. Diagnosing PAMM requires a high level of suspicion since it can present without significant changes in visual acuity, visual fields, and fundus photographs. With the inclusion of en face OCT in the clinicians’ diagnostic armamentarium, the slightest signs of retinal ischemic changes, such as PAMM, become evident. |
| first_indexed | 2024-03-09T14:01:47Z |
| format | Article |
| id | doaj.art-3f5ccf94dc71489a92a3adee145f8219 |
| institution | Directory Open Access Journal |
| issn | 1663-2699 |
| language | English |
| last_indexed | 2024-03-09T14:01:47Z |
| publishDate | 2023-10-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Ophthalmology |
| spelling | doaj.art-3f5ccf94dc71489a92a3adee145f82192023-11-30T07:27:23ZengKarger PublishersCase Reports in Ophthalmology1663-26992023-10-0114159159510.1159/000534346534346Paracentral Acute Middle Maculopathy in Migraines with AuraDaniel Milad0Fares Antaki1Andrew Farah2Karim Hammamji3Marc Saab4Department of Ophthalmology, Université de Montréal, Montreal, QC, CanadaDepartment of Ophthalmology, Université de Montréal, Montreal, QC, CanadaFaculty of Medicine, McGill University, Montreal, QC, CanadaDepartment of Ophthalmology, Université de Montréal, Montreal, QC, CanadaDepartment of Ophthalmology, Université de Sherbrooke, Sherbrooke, QC, CanadaParacentral acute middle maculopathy (PAMM) has recently been described following episodes of migraine. In this report, we present a case of PAMM and describe the role of en face optical coherence tomography (OCT). A 75-year-old woman presented with subjective vision loss over a 2-week period in the right eye. She was known for migraines with aura that presented with progressive spreading of positive and negative visual phenomena which usually resolved in under an hour. Her recent migraine episode was “atypical,” as it lasted 3 days. She also experienced a monocular central scotoma with “black spots and jagged, zig-zag edges.” The positive auras resolved spontaneously, whereas the central scotoma persisted. Spectral domain OCT showed an area of perifoveal hyperreflectivity from the inner plexiform to the outer plexiform layers consistent with PAMM. The mid-retina en face OCT and OCT angiography demonstrated an ovoid focal patch of hyperreflectivity with flow interruption, characteristic of globular PAMM. We diagnosed her with migraines with aura and presumed retinal vasospasm, complicated by retinal ischemia in the form of globular PAMM. Acute retinal ischemia, which may require urgent neurovascular workup and giant cell arteritis evaluation, must be considered in patients with migraines alongside persistent visual changes. Diagnosing PAMM requires a high level of suspicion since it can present without significant changes in visual acuity, visual fields, and fundus photographs. With the inclusion of en face OCT in the clinicians’ diagnostic armamentarium, the slightest signs of retinal ischemic changes, such as PAMM, become evident.https://beta.karger.com/Article/FullText/534346optical coherence tomographyacute retinal ischemiaen face optical coherence tomographyoptical coherence tomography angiographyparacentral acute middle maculopathy |
| spellingShingle | Daniel Milad Fares Antaki Andrew Farah Karim Hammamji Marc Saab Paracentral Acute Middle Maculopathy in Migraines with Aura Case Reports in Ophthalmology optical coherence tomography acute retinal ischemia en face optical coherence tomography optical coherence tomography angiography paracentral acute middle maculopathy |
| title | Paracentral Acute Middle Maculopathy in Migraines with Aura |
| title_full | Paracentral Acute Middle Maculopathy in Migraines with Aura |
| title_fullStr | Paracentral Acute Middle Maculopathy in Migraines with Aura |
| title_full_unstemmed | Paracentral Acute Middle Maculopathy in Migraines with Aura |
| title_short | Paracentral Acute Middle Maculopathy in Migraines with Aura |
| title_sort | paracentral acute middle maculopathy in migraines with aura |
| topic | optical coherence tomography acute retinal ischemia en face optical coherence tomography optical coherence tomography angiography paracentral acute middle maculopathy |
| url | https://beta.karger.com/Article/FullText/534346 |
| work_keys_str_mv | AT danielmilad paracentralacutemiddlemaculopathyinmigraineswithaura AT faresantaki paracentralacutemiddlemaculopathyinmigraineswithaura AT andrewfarah paracentralacutemiddlemaculopathyinmigraineswithaura AT karimhammamji paracentralacutemiddlemaculopathyinmigraineswithaura AT marcsaab paracentralacutemiddlemaculopathyinmigraineswithaura |