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Retinal Migraine — SCE Neurology MCQ

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HardHeadache & Facial PainRetinal MigraineSCE Neurology

A 45-year-old man presents with a 2-year history of recurrent episodes of transient unilateral visual loss (amaurosis fugax) lasting 5–10 minutes. He has ipsilateral headache with each episode. Between episodes, his vision is completely normal. Fundoscopy during an episode shows retinal pallor. His carotid arteries are normal on Doppler. MRI brain is normal. He has no cardiovascular risk factors. What is the most likely diagnosis?

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Correct answer: D — Retinal migraine

Retinal migraine is characterised by repeated episodes of fully reversible monocular visual disturbance (scotoma, blindness) lasting <60 minutes, associated with migraine headache, in the absence of other causes. Fundoscopy during an episode may show retinal artery vasospasm with pallor. It is a diagnosis of exclusion — carotid disease, GCA, cardiac emboli, and antiphospholipid syndrome must be excluded. A: Carotid Doppler is normal. C: GCA is unlikely in a 45-year-old without inflammatory markers. D: CRAO is usually permanent. E: Optic neuritis causes pain with eye movement and disc swelling.

Reference: ICHD-3 (2018); NICE CG150