Acute monocular oligemia in a patient with migraine with aura demonstrated using OCT-angiography: A case report

Introduction: Migraine is one of the most common causes of transient visual loss. Optical coherence tomography angiography (OCTA) provides fast and non-invasive imaging of the retinal vessels. We report one case of monocular retinal oligemia demonstrated using OCTA during a migraine attack with aura. Case description: A 27-year-old man with a previous history of migraine with visual aura was seen in the emergency room due to acute left hemicranial pain with positive visual symptoms in his right eye. The patient reported a blue stain in his right eye. Optical coherence tomography angiography (OCT-A) showed an extensive area of hypoperfusion in the macular region of his right eye. Forty-eight hours later visual symptoms had improved and the OCT-A showed a significant reduction in the area of hypoperfusion. Seven days later the patient was asymptomatic and retinal perfusion had returned to normal values. Conclusion: Monocular involvement suggests that these retinal vascular changes are independent from cerebral vascular changes, supporting the hypothesis of selective retinal ganglion cell layer spreading depression as the possible cause of some cases of retinal migraine.

Automated summary

Optical coherence tomography angiography (OCTA) can be used to observe retinal vascular changes during migraine attacks. This case report demonstrates an extensive area of hypoperfusion in the macular region of the right eye using OCTA in a migraine patient. The involvement of only one eye supports the theory of selective retinal ganglion cell layer spreading depression.