title: Effects of visual pathway lesions on the visual aura of migraine.
abstract: The aim was to to determine if the visual aura of migraine is altered by disease of the afferent visual pathways and if visual aura changes are associated with pre- or postgeniculate lesions. Functional neuroimaging during migraine demonstrates primary visual/extrastriate cortex as an anatomical substrate of visual aura. Neuro-ophthalmological records (including kinetic and static perimetry) of 25 patients with visual loss and typical aura with or without migraine headache were reviewed. Twenty-five patients (16 women, nine men) (mean age 59.8 years) with typical aura had visual loss from pregeniculate (72%) or postgeniculate lesions (28%). Eight patients (four postgeniculate cerebrovascular accidents or arteriovenous malformations, two lifelong optic neuropathy/retinopathy, one childhood ocular trauma, one anisometropic amblyopia) reported absence or alteration of visual aura. Postgeniculate lesions were significantly associated (P = 0.017) with visual aura changes. The association of postgeniculate lesions with altered auras points to a postgeniculate effect on aura appearance (consistent with functional neuroimaging findings). Although statistically significant, this series' association of postgeniculate disease and aura changes is even more robust (P = 0.0002) when structural changes of ocular dominance columns are posited in three patients with optic neuropathy, retinopathy and keratopathy of congenital or childhood origin.
authors.affiliation: Department of Neurology, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA. leporefe@umdnj.edu
authors.forename: F E
authors.initials: FE
authors.lastname: Lepore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications / Q000473:pathology*; D014786:Vision Disorders / Q000150:complications / Q000473:pathology*; D014793:Visual Cortex / Q000473:pathology; D014795:Visual Pathways / Q000473:pathology*; D055815:Young Adult