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jruddy	Here's a new one for me...		Lead	[-]
Regular Visitor Posts: 413 03/01/08 9:34 AM	Remove this ad After a fairly good VS day yesterday, I woke up with a scotoma in the centre of my vision - I figured I was going to have a migraine, but didn't. Instead I got indoor "skyworms" and awful positive afterimages which lasted around 2 or 3 minutes and now my VS is quite bad, which is annoying because normally the morning is my "good time" so far as VS goes. The positive afterimages were popping on anything of any level of contrast - my closet doors, art work on the wall, where the wall meets the ceiling, where two walls meet, my dresser etc... I don't have a migraine head-ache - but I do have a head-ache, though that's nothing new. I assume this is some kind of funky migraine episode. No ice pick to the head, no nausia so I'm happy.
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ksomething		#1	[url]	[-]
Registered User Posts: 5010 03/01/08 9:36 AM	Can you make a picture of the central scotoma?
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jruddy		#2	[url]	[-]
Regular Visitor Posts: 413 03/01/08 9:54 AM	My eyes don't thank you...
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ksomething		#3	[url]	[-]
Registered User Posts: 5010 03/01/08 10:09 AM	Is it still the case that your doctors didn't make a clear diagnosis? Then it would be good to have another visual field test from an ophthalmologist soon because it may be possible to objectivize the central scotoma with visual field testing. The sky worm first appeared only in bright sky, then against grey sky, now (for the first time?) indoors. The sky worms always occur in short attacks, not on a daily recurring basis, right?
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jruddy		#4	[url]	[-]
Regular Visitor Posts: 413 03/01/08 10:21 AM	I believe the diagnosis from the Neuro is complicated migraine. I see an opthamologist on March 26th - they're hard to get in to see around here - I suspect because of the heavy industry and eye injuries? This is the first spontaneous attack of skyworms and the first time I've seen them indoors. The other times I had to force them to come by looking at a bright field - grey or blue sky - for 10-15 seconds. The VS phenominon is always worse when I first wake up, but usually clears up. I have woken up with migraine auras which have led to migraines in the past. I discussed seeing a neuro-opthamologist with my GP again he was supportive but doesn't know any - so is unsure of who to send me to - I'm going to discuss it with the neuro on monday. Most neuro-opthamologists are in London, Ontario, a city around 150 km away, though I believe I have a contact to one only 50 km away. Anyways, typing this is torture, I should be taking it easy, visually... Cheers.
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shannon3fh		#5	[url]	[-]
Regular Visitor Posts: 449 03/01/08 10:24 AM	to get into the eye drs eairly i just called and said i am really struggling here, i need to be seen lol and i went in that day haha you can try that.
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ksomething		#6	[url]	[-]
Registered User Posts: 5010 03/01/08 10:27 AM	Remove this ad Complicated migraine is a synonym to persistent aura without infarction, so the (according to my opinion) right diagnosis has been made. Central scotomas can occur as migraine aura symptom, so that's the most likely explanation. Some visual rest is probably the best to do right now. Greetings, K
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jruddy		#7	[url]	[-]
Regular Visitor Posts: 413 03/01/08 3:30 PM	Hi Dr K. I'm doing better now, just the usual afternoon snow with a little extra noise thrown in for good measure... Before a migraine, I often get a negative scotoma that I only pick up on if I'm trying to read or look at something detailed. It turns into a grey/silver scintillating scotoma / start of an aura which is what I saw this morning. This is why I thought I was getting a migraine. It fizzled out though. I have had migraine scotomas/auras recede before but not very often, maybe 3 times in my life, not counting this morning's odd sky-worm episode. I also saw the worms in the snow this afternoon wearing sun glasses. Er, I was wearing sun glasses, not the worms... Cheers. Jim
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ksomething		#8	[url]	[-]
Registered User Posts: 5010 03/01/08 3:34 PM	That's good news. So the central scotoma has already disappeared?
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jruddy		#9	[url]	[-]
Regular Visitor Posts: 413 03/01/08 7:51 PM	Ah, now I understand your concern. I need to work on my communication skills. 1 - I woke up with a scotoma. It lasted a few minutes then receded. 2 - The skyworms appeared and I developed awful positive after images - this lasted a few minutes. 3 - Along with the worms I had a huge increase in Visual snow and other symptoms, after images, foggy mind, sparkles etc... lasted for around 5 hours. I saw Sky worms in the snow. 4 - The Visual Snow calmed down to regular levels. 5 - Around 4 hours later I developed a pretty bad headache - but not a migraine but worse than the headache I had earlier. 6 - Advil has taken care of the headache but now my vision is awful again, but it is evening and it's been an interesting day so I'm not surprised. Thank you, sorry for the confusion!! Last Edited By: jruddy 03/01/08 7:54 PM. Edited 1 time.
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ksomething		#10	[url]	[-]
Registered User Posts: 5010 03/02/08 11:24 AM	Thanks for clearing this up. I was indeed worrying that might be a new persistent thing (the central scotoma). Your observation shows several points in greatest clearness. On one level, it's a classical description of an attack of migraine with aura, with first the aura symptoms (scotoma -> sky worms -> sparkles) and then 4 hours later the headache attack. Moreover, it shows an attack of migraine with aura that starts in sleep and carries over into the awake state (because when you awoke the scotoma had already some size, as depicted in your picture, i.e. you have missed the beginning whilst you were still asleep). Then it shows the feature that during an attack of migraine with aura (more precisely, durin g the aura phase) you can whave a transitory worsening of the intensity of persistent aura symptoms, i.e. by the time ther sky worms set in you had a transitory worsening of positive afteri,mages (which are one of your persistent symptoms) and a transitory worsening of visual snow (which is another of your persistent symptoms). It would be great if you could make a pictorial documentation of this sequence with Fig. 1 = the onset with the scotoma (immediately after awakening) + background level visual snow Fif. 2 = the maximum size of scotoma (or was it stable size after awakening, i.e. did not get larger) + background level visual snow Fig. 3 = scotoma almost receded + background level visual snow Fig. 4 = skyworms appeared + background level visual snow Fig. 5 = skyworms visible + worsening of positive afteri,ages + worsening of visual snow Fig. 6 = skyworms visible + sparkles + worsening of positive afteri,ages + worsening of visual snow Fig. 7 = did the worsening of the positive afterimages and the visual snow last longer than the skyworms, then picture should show: worsening of positive afteri,ages + worsening of visual snow Fig. 8 = return to background level visual snow
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ksomething		#11	[url]	[-]
Registered User Posts: 5010 03/02/08 11:28 AM	Your observation is also very instructive because it is relevant to the frequent phenomenon that one feels a transitory worsening of intensity of persistent symptoms after awakening. One hypothesis to explain this is to assume that one has had an attack of migraine with aura in sleep and when one awakens one just experiences the "usual" worsening of intensity of persistent aura symptoms with an attack of migraine with aura. In your experience, the whole thing began during sleep and carried over into awake state, so that one can verify that it's an attack of migraine with aura. (see http://www.migraine-aura.org/content/e27891/e27265/e42285/e52203/e52341/index_en.html ) Therefore such a full documentation of this attack would be most valuable as piece of evidence in different questions.
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jruddy		#12	[url]	[-]
Regular Visitor Posts: 413 03/02/08 3:31 PM	Remove this ad Well... I can't say for certain if I can do this accurately. Either the Topamax or the persistant aura (or both) has been messing with my short term memory (or is it something else?) and while I can remember somewhat of the sequence, I'm not sure that I could accurately put it into pictures at this point... The memory and thinking problems have been going on since the VS started and I think it has been worse since starting either the Topamax or the Citalopram. I do know that I had some memory loss with some migraines in the past, that is, I could not recall what I had experienced, and ended up creating migraine logs to track their sequence... so it is possible the memory problems are associated with the persisting aura. I can tell you that every morning the VS is worse for me - but I don't think I've had a migraine episode. Usually it improves pretty quickly then slowly degrades throughout the day. I don't recall the timing for the improvement, I can check the next few mornings and let you know. I can take a 5 minute nap and when I wake up my VS is much worse. Even if I just close my eyes for 5 minutes and don't sleep, the VS is worse when I open them...
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