A 40-year-woman sees a flickering zigzag line traverse the right hemifield of both eyes over a period of 20 minutes. A mild headache follows. She denies any previous episodes of this sort, has never had "migraine headaches," and denies any family history of this. She has no known medical problems. What is the likely diagnosis?
Incorrect. A partial occipital seizure can cause a transient visual disturbance but it does not usually migrate across the visual field. Try again!
Incorrect. Vertebrobasilar transient ischemic attack can cause a visual disturbance that lasts 20 minutes, but it does not migrate across the visual field. Try again!
Correct. The migraine visual “aura” is commonly a sparkling zigzag that migrates across the visual hemifield and obscures it. Headache may follow, but migraine may also consist purely of a visual aura without headache (“acephalgic migraine,” “migraine equivalent”), especially in elderly patients.
Incorrect. Hypotension, or low blood pressure, can result in symptoms that mimic a transient ischemic attack, but the visual disturbance more commonly lasts only seconds to minutes, not the 20 minutes described by this patient. Try again!