Sudden loss of vision during pregnancy: Migraine with visual aura presenting with quadranopsia

Abstract

Migraine aura without headache can be easily diagnosed from an appropriate migraine history. However, diagnosis is more difficult with a different migraine pattern, especially during pregnancy. A 32-year-old woman in her 37th week of pregnancy presented with quadranopsia in the upper outer quadrant of the left eye. There were no signs of meningismus, sensory or motor deficits. Visual field examination revealed quadranopsia, which lasted 40 minutes and spontaneously resolved. Subsequently, a typical migraine headache began. Several studies have reported that migraine improves in most women during pregnancy. Migraine headaches start de novo during pregnancy in approximately 10% of cases, and the new-onset migraine is often accompanied by migraine aura. Migraine with aura is one of the most common disorders underlying transient focal neurological symptoms among pregnant women. Emergency physicians should take care about pregnant woman presenting with visual disturbance, and consider migraine as differential diagnosis.