Woman with blurred vision
Author and Disclosure Information [Show]

Jasmin Harpe, MD, MPH, Headache Fellow, Department of Neurology, Harvard University, John R. Graham Headache Center, Mass General Brigham, Boston, MA.

Jasmin Harpe, MD, MPH, has disclosed no relevant financial relationships.

Question 1 of 3

A 34-year-old Hispanic woman presents to an urgent care clinic with paroxysmal homonymous blurred vision. She has had visual symptoms once to twice a year for the past few years, which usually present as different shapes located in the right visual field and are characterized by zigzagging and shimmering blue colors. When she closes each eye, the visual disturbance is still present in the right visual field. During each episode, the visual symptoms disappear after 30 minutes and are not accompanied by headache, nausea, photophobia or phonophobia, amaurosis, diplopia, limb weakness, or speech disorder.

The patient does not have a medical history of hypertension, diabetes, cardiovascular disease, stroke, headache, or familial genetic diseases. She drinks a glass of wine most nights before dinner. She is a never-smoker. The only medication she takes is oral contraceptives.

Neurologic examination was normal. Ophthalmic examination was normal, with a normal visual field. A 3D optic coherence tomography showing the thicknesses of the macula, optic disc, and retinal nerve fiber layer was normal. Routine laboratory tests also yielded normal results: thyroid hormone values, antithyroid peroxidase antibody level, antineutrophil cytoplasmic antibodies, and cellular and humoral immune indexes were normal.

A chest radiograph, EEG, echocardiogram, and visual evoked potential examination results that were normal. A carotid Doppler ultrasound revealed no carotid plaque, and her common carotid artery intima-media thickness was 0.7 mm. Brain MRI, brain CT angiography, and neck magnetic resonance angiography examinations were normal.

What is the likely diagnosis in this patient?

Migraine aura without headache

Transient ischemic attack

Epileptic seizure

Multiple sclerosis

This quiz is not accredited for CME.

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