In general, AcomA aneurysms tend to rupture, while they are relatively small and cause visual symptoms. Thus, scintillating scotoma may be a type of optic neuropathy.ĪcomA aneurysms rarely present with symptoms of compression of the anterior visual pathways. reported a case of optic neuritis mimicking migraine with scintillating scotoma. Nevertheless, optic nerve compression is likely to cause scintillating scotoma as the optic nerve is a key visual pathway. To our knowledge, there are no previous reports of scintillating scotoma caused by optic nerve compression, including that it is caused by brain lesions such as tumors or aneurysms. In our patient, the aneurysm compressed the right optic nerve. The propagation of spreading depression through the visual cortex will create similar visual phenomena, whatever the original cause. In that study, the lesions were located in the occipital lobe, which contains the primary visual cortex. also reported several cases of migraine-like visual aura secondary to cerebral lesions, including infarction, arteriovenous malformations, and tumors. Cortical spreading depression is a slowly propagating wave of neuronal and glial depolarization. Scintillating scotoma is commonly associated with migraines, with a potential mechanism involving cortical spreading depression. We present a case of scintillating scotoma with an unruptured AcomA aneurysm.
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