Scintillating scotoma

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Scintillating scotoma
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Visual aura, zigzag patterns, blind spot
Complications	Migraine
Onset	Sudden
Duration	Typically 20–30 minutes
Types	N/A
Causes	Cortical spreading depression
Risks	Migraine history, stress, hormonal changes
Diagnosis	Clinical evaluation
Differential diagnosis	Retinal detachment, ocular migraine, transient ischemic attack
Prevention	N/A
Treatment	Rest, dark room, pain relief for associated migraine
Medication	N/A
Prognosis	N/A
Frequency	Common in individuals with migraines
Deaths	N/A

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Scintillating scotoma is a visual phenomenon that is often associated with migraine headaches but can occur independently. It is characterized by a temporary, partial field of vision disturbance that usually affects both eyes. Individuals experiencing a scintillating scotoma may see flickering or shimmering lights, blind spots, or geometric patterns, often with a zigzag border that can expand and move across the field of vision. This phenomenon typically precedes the headache phase of a migraine in what is known as the aura phase, although it can also occur without any subsequent headache.

Causes and Mechanisms

The exact cause of scintillating scotoma is not fully understood, but it is believed to be related to a wave of electrical activity that sweeps across the brain, specifically the cerebral cortex, which is responsible for processing visual signals. This phenomenon is known as Cortical spreading depression. It temporarily alters neural activity and blood flow in the brain, leading to the visual disturbances characteristic of scintillating scotoma.

Symptoms

Symptoms of scintillating scotoma include:

• Visual disturbances that appear as flickering or shimmering lights
• Zigzag patterns that may expand and move across the field of vision
• A blind spot or partial loss of vision that typically lasts less than an hour
• Headache, which may follow the visual symptoms, although not always

Diagnosis

Diagnosis of scintillating scotoma primarily involves a detailed medical history and a physical examination. Healthcare providers may also perform a comprehensive eye examination to rule out other potential causes of visual disturbances. In some cases, further testing, such as MRI scans, may be conducted to exclude neurological conditions.

Treatment

There is no specific treatment for scintillating scotoma. Management strategies focus on treating the underlying migraine condition, if present, and may include medications to relieve migraine symptoms or prevent migraine attacks. For individuals who experience scintillating scotoma without subsequent migraines, lifestyle modifications and avoiding known migraine triggers may be recommended to reduce the frequency of episodes.

Prevention

Preventive measures for scintillating scotoma involve identifying and avoiding personal migraine triggers, which may include stress, certain foods, or changes in weather. Regular exercise, adequate sleep, and maintaining a healthy diet can also help reduce the frequency of migraine attacks and associated visual disturbances.

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