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JAMA Ophthalmology Clinical Challenge
September 2018

Bilateral Visual Field Loss in an Adolescent Girl With Migraine Headaches

Author Affiliations
  • 1Medical Eye Center of New Hampshire, Manchester
JAMA Ophthalmol. 2018;136(9):1072-1073. doi:10.1001/jamaophthalmol.2017.6815

A girl in her midteens presented to an ophthalmology practice with her parents reporting worsening blurry vision on the right side for the past 2 weeks. She had a history of migraine headaches, for which she took nonsteroidal anti-inflammatory drugs for symptomatic relief. At her examination, she reported feeling tired but denied other medical problems.

On examination, her visual acuity was 20/20 OU. Intraocular pressure was 15 mm Hg OU, extraocular motility was normal, and findings of the anterior segment examination were normal. There was no afferent pupillary defect, and dilated fundus examination revealed healthy-appearing optic nerves and normal retinas. Automated perimetry demonstrated a right-sided homonymous hemianopia. Magnetic resonance imaging of the brain performed the same day revealed subacute infarction of portions of the left occipital, temporal, and parietal lobes (Figure).