Scintillating scotoma, kind of?

You are not a doctor (or at least you’re not my doctor, who know, perhaps you’re a doctor of theology), but I was wondering if anyone might have some insight as to an odd symptom I’ve experienced three times now:

I’ll just be minding my own business, usually after huffing around campus a little bit too hard during a recess, but I’ll notice that I’m having a hard time reading my overheads, and then realize it’s because this odd visual disturbance is obscuring my field of vision, with sparkly colorful twinkly action moving in from the left side of my field of vision: it usually ends up obscuring about 1/3 of my sight for about 20 minutes, and then fades away. The closest description I’ve found is something called “scintillating scotoma”, which usually seems to be black and white streaks in the center of the field, and typically followed by a migraine headache (which I thankfully have not yet experienced.)

Another term that pops up is “Teichopsia” which sounds closer to what I am experiencing. It seems mostly harmless and even a little novel and entertaining: who doesn’t like sparkly lights? Does anyone have a clue what might cause this?

High blood pressure. How is your BP?

Don’t take chances with your vision. See a professional immediately.

It’s called an optical (or ophthalmalogical) migraine, and mostly they have no known cause and are typically benign. Whilst some people get them as a precursor to a ‘head’ migraine with the accompanying pain, for many others the visual disturbance is the only symptom they have.

IANAD etc.

ALmost certainly ocular migraine.

I get these all the time. I get the headaches too, but the ocular manifestations are never painful for me. The full on migraine headache for me is always without ocular symptoms. A bit atypical.

But go see your doctor.

What everyone else said.

I just wanted to add that your description of scintillating scotoma in migraines (also known as an “aura”) is atypical.

Typically they begin as colourful sparkles in the centre of vision, which become a sparkly arc, which enlarges and moves outwards to the periphery of the visual field, eventually moving off the visual field entirely. The whole process takes around 30 minutes.

It is believed that this phenomenon is caused by cortical spreading depression – a phenomenon where a wave of increased activity moves slowly across the brain, leaving a volume of depressed activity in its wake.
Exactly what causes CSD though, why it proceeds at the speed it does, and why CSD may or may not be followed by a headache, are questions with detailed, and far from complete, answers.

IANAD, but I did write a paper on CSD as part of my Master’s.

I used to get auras with migraines but they were of the black & white variety. When I first was prescribed Celexa I experienced the scintillating lights in my visual path that were also very bright even when my eyes were closed. The air around me seemed to pop and fizz like champagne for the first couple of days. It was very disorienting. I was, like, on drugs, man.

Happily, they never reappeared unless I was extremely exhausted but it was quite tiring having to deal with the Las Vegas lights effect while I was trying to concentrate in meetings.

Another vote for ocular migraine. I get these occasionally, and they aren’t always followed by head pain (and the overwhelming majority of my “head” migraines are not preceded by scintillating scotoma).

Please see a doctor.

See your doctor anyway, just to make sure you’re OK. But, I work in ophthalmology (IANAD/N), and I also have migraines, including the ocular kind. “Scintillating scotoma” or “aura” are the proper terms.

The actual painful migraine part is optional - if you don’t get it, that’s because the migraine was confined to your retina (back of the eye where all those little rods and cones are), which is technically part of the brain.

Visual symptoms which are bilateral occur at the level of the optic chiasm (where the optic nerves meet, join, and cross), or more proximate (meaning all the way back to the visual cortex). Unilateral visual disturbances can be at the level of a single eye.

As a rule of thumb, homonymous (both eyes; same field of vision) disturbances reflect something happening within a unilateral visual cortex. See a visual pathways chart (Figure 8) to understand why this is so. The left side field of vision is mapped back to the right visual cortex (Point G in that Figure 8), so if symptoms are bilateral a likely area that is involved is the right occipital visual cortex.

If, on the other hand, a visual disturbance is unilateral, involving only one eye, the problem is more likely to be local to the eye, although this is not technically an absolute requirement–in medicine almost nothing is “always.”

Scintillating “scotoma” (the term is a bad one, because scotomas are traditionally dark or absent-vision spots, and as it’s used with migraines etc, “scotomas” tend to be flashes) are often associated with “migraines.” No one really knows what actually causes migraines, and in the wonderful chaos of medical terminology, the term “ocular migraine” is used to refer to the visual symptoms accompanying an episode of whatever the heck a “migraine” is. Headache may or may not be associated with the phenomenon. Putative causes have included vasospasm, but the pathophysiology is not worked out. Ultimately, whatever the trigger and whatever the pathophysiology, what’s happening with visual auras is that the visual cortex is being disturbed and the neurons are firing inappropriately.

Every symptom complex has a differential diagnosis, even when symptoms have classic patterns. Among the considerations for visual disturbances are seizures and other brain pathology, although classic “migraine” type symptoms are not always pursued vigorously if there are no other causes for concern. New symptoms are often given a more careful evaluation than long-standing ones which have remained stable.