Department of Neurology, University Hospital, LMU Munich, Munich, Germany; Department of Neurology, Inselspital, University Hospital Bern, Switzerland; Department of Ophthalmology, University of Tübingen.
Dtsch Arztebl Int. 2021 Oct 1;118(39):647-653. doi: 10.3238/arztebl.m2021.0287.
Visual phenomena are of many different kinds; their differential diagnosis is usually possible with directed history-taking. In this review, we describe common visual phenomena that must be distinguished from a migraine aura.
This review is based on publications retrieved by a selective search in PubMed and the Web of Knowledge/Science, with special attention to the current classification of the International Headache Society and the recommendations of the German Migraine and Headache Society. The following search terms were used: "visual phenomena/phenomenon," "migraine aura," and "persistent/complication/ long-lasting/ongoing."
The most helpful questions for differential diagnosis are whether the symptoms are present in one eye only or in both, whether their onset was sudden or over minutes or days, and whether the phenomenon has occurred only once or repeatedly, or is persistently present. A visual aura associated with migraine must be distinguished, in rare cases, from an isolated epileptic aura, from cerebral/retinal ischemia, or from visual snow. Further differential diagnoses include a persisting perceptual disturbance after hallucinogen use (HPPD, "hallucinogen persisting perception disorder") and the Charles Bonnet syndrome (CBS); the latter arises as a consequence of severely impaired vision. Posterior reversible encephalopathy syndrome (PRES) is rare and generally reveals itself over its further course through the appearance of additional clinical manifestations. Primary ophthalmological causes can usually be readily identified and classified by ophthalmological examination.
Patients with visual phenomena typically consult physicians from various medical specialties. A correct differential diagnosis can be made based on the history if the physician views the symptoms in their overall context to determine the particular disease entity that is responsible.
视觉现象有多种类型；通过有针对性的病史询问，通常可以对其进行鉴别诊断。在本篇综述中，我们描述了必须与偏头痛先兆相鉴别的常见视觉现象。
这篇综述基于在 PubMed 和 Web of Knowledge/Science 中进行选择性检索而获得的出版物，特别关注国际头痛协会的当前分类和德国偏头痛和头痛协会的建议。使用了以下搜索词：“视觉现象/现象”、“偏头痛先兆”和“持续/并发症/长期/持续”。
最有助于鉴别诊断的问题是症状是仅出现在一只眼还是两只眼，症状的起始是突然的还是在数分钟或数天内逐渐出现，以及现象是仅出现过一次还是多次，还是持续存在。必须将偏头痛相关的视觉先兆与罕见的孤立性癫痫先兆、脑/视网膜缺血或视觉雪相鉴别。进一步的鉴别诊断包括使用致幻剂后持续的知觉障碍（HPPD，“幻觉持续知觉障碍”）和 Charles Bonnet 综合征（CBS）；后者是严重视力障碍的结果。后部可逆性脑病综合征（PRES）很少见，通常会在进一步的病程中通过出现其他临床表现来显现。原发性眼科原因通常可以通过眼科检查来明确和分类。
有视觉现象的患者通常会咨询来自多个医学专业的医生。如果医生将症状置于其整体背景下来判断导致症状的特定疾病实体，基于病史可以做出正确的鉴别诊断。
