[Late onset visual aura associated with a carotid artery stenosis reversible after endarterectomy]

Abstract

Background: Visual aura is the most common type of aura. Onset of visual aura occurring for the first time in an elderly person is atypical, even though late-life migraine accompaniments are well-recognized.

Observation: We report the case of a 72-year-old woman with a past history of migraine without aura since adolescence (one attack per month), who experienced for the first time of her life multiple visual aura over a period of more than one year. These auras were always left homonymous hemianopia which developed gradually over 5 mins followed by severe migraine headache without strict lateralization. The patient was known to have a moderate right carotid artery stenosis. In October 2007, she suffered a minor ischemic stroke in the right carotid artery territory due to progression to severe stenosis of the right internal carotid artery. After carotid endarterectomy, she had no further migraine attacks with aura.

Discussion: We discuss the mechanism of aura in our case with probable microemboli due to the severe right internal carotid artery stenosis responsible for repeated cortical spreading depression.

Conclusion: Clinicians should bear in mind to systematically explore all patients with late onset aura including patients who have previously suffered from migraine without aura and also to explore patients who have a dramatic increase of aura even if they are already migrainers with aura.