Migraines are commonly associated with a visual aura that has a characteristic clinical presentation. Cortical lesions within or in close proximity to the retrochiasmal visual pathways may also present in a manner that mimics migrainous visual phenomena and, in some cases, may be too small to manifest with a visual field defect on formal testing. We present 4 patients (3 females and 1 male) with an average age of 48.5 (range 28–67) years who had migraine-like visual disturbances related to a right temporal meningioma, occipital cavernoma, occipital lobe infarction, and demyelination in the optic radiations, which was the presenting sign of multiple sclerosis. No patient underwent neurosurgical intervention, and 1 patient (occipital lobe infarct) had complete resolution of the symptom after initial presentation. All patients had normal visual fields at follow-up and no thinning evident on optical coherence tomography. Our cases emphasize the importance of a history in assessing patients with transient positive visual phenomena and identify pathology that may present without visual field defects. Clinical features that should raise a doubt about a diagnosis of migraine visual aura include the absence of headache, brief visual disturbance lasting #x3c;5 min or those lasting #x3e;60 min, and age #x3e;40, especially with no past medical history of migraine.
Case Rep Ophthalmol 2021;12:653–658

中文翻译：

---

与无法检测视野缺损的局灶性皮质病变相关的偏头痛样阳性视觉现象

偏头痛通常与具有特征性临床表现的视觉先兆有关。视交叉后视觉通路内或附近的皮质病变也可能以模仿偏头痛视觉现象的方式出现，并且在某些情况下，可能太小而无法在正式测试中表现出视野缺损。我们介绍了 4 名患者（3 名女性和 1 名男性），平均年龄为 48.5（范围 28-67）岁，他们患有与右侧颞部脑膜瘤、枕部海绵状血管瘤、枕叶梗死和视神经脱髓鞘相关的偏头痛样视力障碍。辐射，这是多发性硬化症的表现。没有患者接受神经外科干预，1 名患者（枕叶梗死）在初次就诊后症状完全消退。随访时所有患者的视野均正常，光学相干断层扫描未见明显变薄。我们的案例强调了病史在评估具有短暂阳性视觉现象的患者和识别可能没有视野缺损的病理的重要性。应该对偏头痛视觉先兆的诊断产生怀疑的临床特征包括无头痛、持续 #x3c;5 分钟或持续 #x3e;60 分钟的短暂视觉障碍和年龄 #x3e;40，尤其是没有既往医疗记录偏头痛病史。
Case Rep Ophthalmol 2021；12:653–658