WordNet

brilliantly clever; "scintillating wit"; "a play full of scintillating dialogue"
an isolated area of diminished vision within the visual field

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/24 12:37:40」(JST)

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Scintillating scotoma is the most common visual aura preceding migraine and was first described by 19th-century physician Hubert Airy (1838–1903). It is often confused with ocular migraine, which originates in the eyeball or socket.

Presentation

An artist's depiction of a scintillating scotoma with a bilateral arc

A depiction of a scintillating scotoma that was almost spiral-shaped, with distortion of shapes but otherwise melting into the background similarly to the physiological blind spot

A depiction of a scintillating scotoma that was almost spiral-shaped, with distortion of shapes but otherwise melting into the background similarly to the physiological blind spot. This displays Widmanstätten patterns^{[citation needed]}

Although many variations occur, scintillating scotoma usually begins as a spot of flickering light near or in the center of the visual field, which prevents vision within the scotoma area. The affected area flickers but is not dark. It then gradually expands outward from the initial spot. Vision beyond the borders of the expanding scotoma(s) remains normal with objects melting into the scotoma area background similarly to the physiological blind spot, which means that in the early stages when the spot is in or near the center, objects may be seen better by not looking directly at them. The scotoma area may expand to completely occupy one half of the visual area, or it may also be bilateral. It may occur as an isolated symptom without headache in acephalgic migraine.

As the scotoma area expands, some people perceive only a bright flickering area that obstructs normal vision, while others describe seeing various patterns. Some describe seeing one or more shimmering arcs of white or colored flashing lights. An arc of light may gradually enlarge, become more obvious, and may take the form of a definite zigzag pattern, sometimes called a fortification spectrum (i.e. teichopsia, from Greek τεῖχος, town wall), because of its resemblance to the fortifications of a castle or fort seen from above.^[1] It also can resemble the dazzle camouflage patterns used on ships in WWII. Others describe patterns within the arc as resembling Widmanstätten patterns.

The visual anomaly results from abnormal functioning of portions of the occipital cortex, at the back of the brain, not in the eyes nor any component thereof, such as the retinas.^[2] This is a different disease from retinal migraine, which is monocular (only one eye).^[3]

It may be difficult to read and dangerous to drive a vehicle while the scotoma is present. Normal central vision may return several minutes before the scotoma disappears from peripheral vision.

Sufferers can keep a diary of dates on which the episodes occur to show to their physician, plus a small sketch of the anomaly, which may vary between episodes.

Causes

Scintillating scotomas are most commonly caused by cortical spreading depression, a pattern of changes in the behavior of nerves in the brain during a migraine. Migraines, in turn, may be caused by genetic influences and hormones. People with migraines often self-report triggers for migraines involving stress and a wide variety of foods.^[4] While monosodium glutamate (MSG) is frequently reported as a dietary trigger,^[5] some scientific studies do not support this claim.^[6]

Scintillating scotoma may also be caused by other serious neurological or cardiovascular conditions, especially when the onset occurs later in life.

Prognosis

Symptoms typically appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes, leading to the headache in classic migraine with aura, or resolving without consequence in acephalgic migraine.^[1] Many migraine sufferers evolve from scintillating scotoma as a prodrome to migraine to scintillating scotoma without migraine. The scotoma typically spontaneously resolves within the stated time frame, leaving few or no subsequent symptoms, though some report fatigue, nausea and dizziness as sequelae.^[7]

References

^ ^a ^b Imigraine.net Migraine With Aura
^ Genetics in Migraine
^ "Retinal Migraine" by Brian Grosberg et al.
^ http://www.centraltexaseyecenter.com/education/scint_scoto.html
^ Sun-Edelstein C, Mauskop A (June 2009). "Foods and supplements in the management of migraine headaches". The Clinical Journal of Pain 25 (5): 446–52. doi:10.1097/AJP.0b013e31819a6f65. PMID 19454881.
^ Freeman M (October 2006). "Reconsidering the effects of monosodium glutamate: a literature review". J Am Acad Nurse Pract 18 (10): 482–6. doi:10.1111/j.1745-7599.2006.00160.x. PMID 16999713.
^ [1] Ekbom, K. (1974). "MIGRAINE IN PATIENTS WITH CLUSTER HEADACHE". Headache: the Journal of Head and Face Pain 14 (2): 69. doi:10.1111/j.1526-4610.1974.hed1402069.x. edit

Notes

Gardner-Medwin AR (1981). "Possible roles of vertebrate neuroglia in potassium dynamics, spreading depression and migraine". J. Exp. Biol. 95: 111–27. PMID 7334315.
Hadjikhani N; Sanchez Del Rio M; Wu O et al. (2001). "Mechanisms of migraine aura revealed by functional MRI in human visual cortex". Proc. Natl. Acad. Sci. U.S.A. 98 (8): 4687–4692. doi:10.1073/pnas.071582498. PMC 31895. PMID 11287655.

External links

AgingEye Times
Youtube Video Depiction of Scintillating Scotoma

UpToDate Contents

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1. 頭痛、片頭痛、および脳卒中 headache migraine and stroke
2. 幻視患者へのアプローチ approach to the patient with visual hallucinations
3. 成人における片頭痛の病態生理、臨床症状、および診断 pathophysiology clinical manifestations and diagnosis of migraine in adults
4. 片麻痺性片頭痛 hemiplegic migraine
5. 成人における中枢神経系の原発性血管炎 primary angiitis of the central nervous system in adults

English Journal

Homonymous Ganglion Cell Layer Thinning After Isolated Occipital Lesion: Macular OCT Demonstrates Transsynaptic Retrograde Retinal Degeneration.

Meier PG1, Maeder P, Kardon RH, Borruat FX.
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society.J Neuroophthalmol.2014 Oct 2. [Epub ahead of print]
: A 48-year-old man was examined 24 months after medial and surgical treatment of an isolated well-circumscribed right occipital lobe abscess. An asymptomatic residual left homonymous inferior scotoma was present. Fundus examination revealed temporal pallor of both optic discs, and optical coherence
PMID 25285723

Central serous chorioretinopathy following hypobaric chamber exposure.

Ide WW.
Aviation, space, and environmental medicine.Aviat Space Environ Med.2014 Oct;85(10):1053-5. doi: 10.3357/ASEM.4073.2014.
BACKGROUND: Hypobaric hypoxic exposures are associated with a number of risks, most notably decompression sickness and various ophthalmologic disorders, including high altitude retinopathy. Central serous chorioretinopathy (CSCR) is an idiopathic condition that typically affects young males and is a
PMID 25245906

Modeling the relative influence of fixation and sampling errors on retest variability in perimetry.

Maddess T.
Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie.Graefes Arch Clin Exp Ophthalmol.2014 Oct;252(10):1611-9. doi: 10.1007/s00417-014-2751-y. Epub 2014 Jul 30.
BACKGROUND: Our previous studies have shown that in standard automated perimetry (SAP) undersampling occurs if sensitivity varies across a visual field faster than the Nyquist rate (Nq) for the standard sampling interval of 6°. This undersampling was shown to be a major source of test-retest variab
PMID 25074042

Japanese Journal

内頸動脈硬化性病変と眼動脈攣縮の合併により一過性黒内障を反復したと思われる一症例

清水麻衣子,杉山哲也,張野正誉,小嶌祥太,池田恒彦
眼科臨床紀要 = Folia Japonica de ophthalmologica clinica 1(11), 1067-1072, 2008-11-15
NAID 10023922146

Related Pictures

★リンクテーブル★

リンク元	「閃輝暗点」「centrocecal scotoma」「scintillation scotoma」

「閃輝暗点」

Scintillating scotoma
	Example of a scintillating scotoma, as may be caused by cortical spreading depression
Classification and external resources
ICD-10	H53.1
ICD-9	368.12
eMedicine	neuro/480
MeSH	D012607