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Patients with migraines experience a wide range of visual disturbances including visual snow

https://www.ncbi.nlm.nih.gov/pubmed/31022065?dopt=Abstract

Neuro-Ophthalmic Symptoms of Primary Headache Disorders: Why the Patient With Headache May Present to Neuro-Ophthalmology.

J Neuroophthalmol

Neuro-Ophthalmic Symptoms of Primary Headache Disorders: Why the Patient With Headache May Present to Neuro-Ophthalmology.

J Neuroophthalmol. 2019 Apr 23;:

Authors: Smith SV

Abstract

BACKGROUND: Primary headache disorders can cause many ophthalmic symptoms that lead many patients to present for neuro-ophthalmic evaluation. Neuro-ophthalmologists frequently encounter these patients in clinical practice.

EVIDENCE ACQUISITION: A literature review was completed in PubMed using the following terms paired with “migraine” and “headache:” dry eye, eye pain, monocular diplopia, binocular diplopia, photophobia, visual field defect, tunnel vision, floaters, amaurosis fugax, transient visual obscuration, autonomic symptoms, anisocoria, visual snow, Alice in Wonderland syndrome, and palinopsia.

RESULTS: Patients with migraine experience a wide range of visual disturbances including aura and more complex perceptual abnormalities such as Alice in Wonderland syndrome and visual snow. Visual disturbances may consist of positive and/or negative phenomena and may be binocular or monocular. Migraine and other primary headache disorders can be associated with photophobia, eye pain, dry eye, autonomic features, and anisocoria.

CONCLUSIONS: Patients with primary headache disorders may experience a wide range of visual and ophthalmic symptoms. An understanding of the typical features of these disorders allows providers to help patients find appropriate treatment without unnecessary testing and to recognize when atypical presentations require additional evaluation.

PMID: 31022065 [PubMed – as supplied by publisher]

PubMed:31022065

Visual snow: Not so benign

https://www.sciencedirect.com/science/article/pii/S0967586819301389

https://www.ncbi.nlm.nih.gov/pubmed/30910546?dopt=Abstract

Visual snow: Not so benign.

J Clin Neurosci

Related Articles

Visual snow: Not so benign.

J Clin Neurosci. 2019 Mar 22;:

Authors: Chen BS, Lance S, Lallu B, Anderson NE

Abstract

Visual snow is the perception of flickering dots throughout the entire visual field and occurs with other symptoms of dysfunctional central sensory processing. We describe a patient who presented with visual snow, illusory visual motion, photopsia, and reduced night vision. He subsequently developed progressive cognitive impairment, myoclonus and ataxia. A diagnosis of sporadic Creutzfeldt-Jakob Disease was confirmed on post-mortem examination more than 49 months after symptom onset. The visual snow syndrome is typically benign, but our patient illustrates that occasionally it is the first manifestation of a serious brain disease. Careful application of the diagnostic criteria for the visual snow syndrome is important, particularly with the use of neuroimaging to exclude pathology in the occipital cortex.

PMID: 30910546 [PubMed – as supplied by publisher]

PubMed:30910546

The Clinical Characteristics and Neurophysiological Assessments of the Occipital Cortex in Visual Snow Syndrome With or Without Migraine

https://www.ncbi.nlm.nih.gov/pubmed/30848479?dopt=Abstract

The Clinical Characteristics and Neurophysiological Assessments of the Occipital Cortex in Visual Snow Syndrome With or Without Migraine.

Headache

The Clinical Characteristics and Neurophysiological Assessments of the Occipital Cortex in Visual Snow Syndrome With or Without Migraine.

Headache. 2019 Mar 08;:

Authors: Yildiz FG, Turkyilmaz U, Unal-Cevik I

Abstract

OBJECTIVE: Visual snow syndrome (VS) is mainly characterized by flickering, little dots in both visual fields. The recognition of the clinical entity of VS has been increasing recently. Diagnosis is based on patient reports and not better accounted for by another diagnosis.

BACKGROUND: The exact pathophysiology of this syndrome is still unknown. In this study, our aim was to investigate the role of neurophysiological assessments of the occipital cortex in VS patients with (VSm ) or without migraine (VSwom ) and the healthy control (HC).

METHODS: To assess the occipital cortex hyperexcitability, we conducted a prospective, observational study to investigate the habituation/potentiation response by repetitive pattern reversal visual evoked potentials (rVEP) and examined the phosphene thresholds (PT) by transcranial magnetic stimulation in VS patients with or without migraine who were admitted to our tertiary headache clinic and the healthy control.

RESULTS: Twenty-nine volunteers were recruited. The VSm (n = 10), the VSwom (n = 7), and the HC group (n = 12) did not differ demographically. Flickering and floaters were reported in all VS patients and flickering in the dark was the most distressing symptomatology in both VS groups. Higher VAS scores for palinopsia (trailing), photophobia, and concentration difficulty were more frequently self-reported by VSm patients. The HC demonstrated habituation; however, there was loss of habituation response and decreased PTs in both groups of VS patients. The N1P1 VEP amplitude ratios of the 10th/1st block from right and left eye stimulation disclosed higher values (lack of habituation) in VSm (1.04 ± 0.2 and 1.06 ± 0.2) and the VSwom (1.05 ± 0.2 and 0.96 ± 0.08) patients compared to the healthy control (0.75 ± 0.1 and 0.79 ± 0.1), P = .002 from right eye and P = .003 from left eye. In the post hoc analysis the VS patients did not differ according to the presence of migraine from right or left eye stimulations (both P > .999). The left occipital cortex PTs were lower in VSm (58.00 ± 6.60) and VSwom (62.14 ± 11.53) and higher in the HC (71.33 ± 5.56) P = .009. In the post hoc analysis the VS patients did not differ according to the presence of migraine (P > .999). The right occipital cortex PTs were lower in VSm (60.30 ± 8.15) and VSwom (62.00 ± 10.95), higher in the HC (69.67 ± 8.04); however, statistically, groups did not differ (P = .087).

CONCLUSIONS: The loss of habituation and lower threshold for occipital cortex excitability were demonstrated electrophysiologically in VS patients. While statistically significant loss of habituation was seen in both VS patients (with or without migraine) in the right eye, statistically significant loss of habituation in the left eye and decreased threshold of left occipital cortex excitability was seen in visual snow with migraine patients. These findings may provide new insights on “visual snow” pathophysiology and serve as an objective and quantitative assessment tool in VS patients.

PMID: 30848479 [PubMed – as supplied by publisher]

PubMed:30848479

No Studies found for: Visual Snow (March 6, 2019)

https://clinicaltrials.gov/ct2/results?cond=Visual+Snow&term=&cntry=&state=&city=&dist=

No Studies found for: Visual Snow

Studies found on ClinicalTrials.gov by a search of: Visual Snow

Amitriptyline as a possible treatment option for Visual Snow Syndrome based on the hypothesis that VSS is a form of peripheral neuropathy and pituitary fatigue

https://www.clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-5-246.php?jid=cmrcr

Visual Snow Syndrome: A Case Report and New Treatment Option
Shauna Wentzell1* and Mary Ryan2
1General Pathology Resident, McMaster University, Canada

2Consultant Endocrinologist and Senior Lecturer, University of Limerick and Bon Secours at Barrington’s, Ireland

Abstract
We present the case of a 47-year-old male who was diagnosed with Visual Snow Syndrome following extensive specialist consults and medical testing. With an unknown pathogenesis, Visual Snow Syndrome is very difficult to treat and there is no one treatment suited for all patients. The patient in this case report was successfully treated with Amitriptyline based on the hypothesis that Visual Snow Syndrome is a form of peripheral neuropathy and pituitary fatigue. With nearly 200 documented cases of visual snow worldwide [1], this case will add to the possible successful treatment options.

Visual Snow: Visual Misperception

https://journals.lww.com/jneuro-ophthalmology/Abstract/2018/12000/Visual_Snow___Visual_Misperception.20.aspx

https://www.ncbi.nlm.nih.gov/pubmed/30095537

Visual Snow: Visual Misperception.

White, Owen B., MD, PhD, FRACP; Clough, Meaghan, PhD; McKendrick, Allison M., PhD; Fielding, Joanne, PhD

Section Editor(s): Biousse, Valérie MD; Galetta, Steven MD

Journal of Neuro-Ophthalmology: December 2018 – Volume 38 – Issue 4 – p 514–521
doi: 10.1097/WNO.0000000000000702
State-of-the-Art Review
Abstract
Author Information
Article Metrics
Background: Visual snow (VS) is a constant visual disturbance described as flickering dots occupying the entire visual field. Recently, it was characterized as the defining feature of a VS syndrome (VSS), which includes palinopsia, photophobia, photopsias, entoptic phenomena, nyctalopia, and tinnitus. Sixty percent of patients with VSS also experience migraine, with or without aura. This entity often is considered psychogenic in nature, to the detriment of the patient’s best interests, but the high frequency of similar visual symptoms argues for an organic deficit. The purpose of this review is to clarify VSS as a true entity and elaborate the nature of individual symptoms and their relationship to each other.

Evidence Acquisition: The literature was reviewed with specific regard to the clinical presentation and psychophysical, neurophysiological, and functional imaging studies in patients with defined visual disturbances that comprise VSS.

Results: Consideration of the individual symptoms suggests that multiple factors are potentially involved in the development of VSS, including subcortical network malfunction and cortical hyperexcitation. Although there is substantial overlap between VSS and migraine syndromes in terms of co-occurring symptoms, both neurophysiological and neuroimaging studies provide substantial evidence of separate abnormalities of processing, supporting these as separate syndromes.

Conclusions: VSS is likely associated with either hyperactive visual cortices or, alternatively, impaired processing of simultaneous afferent information projecting to cortex. VSS likely results from widespread disturbance of sensory processing resulting in sensory misperception. There may be a number of syndromes associated with impaired sensory processing resulting in sensory misperception, including migraine, persistent perceptual postural dizziness, and tinnitus, which overlap with VSS. Elucidation of abnormality in one defined syndrome may provide a path forward for investigating all.

Evidence of dysfunction in the visual association cortex in visual snow syndrome

https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.25372

Evidence of dysfunction in the visual association cortex in visual snow syndrome

Ann Neurol. 2018 Dec;84(6):946-949. doi: 10.1002/ana.25372. Epub 2018 Nov 30.
Evidence of dysfunction in the visual association cortex in visual snow syndrome.
Eren O1, Rauschel V1, Ruscheweyh R1, Straube A1, Schankin CJ1,2.
Author information
Abstract
Patients with visual snow syndrome (VS) suffer from a debilitating continuous visual disturbance of unknown mechanism. The present study tested the hypothesis of dysfunctional visual processing using visual evoked potentials. Eighteen patients were compared to age-matched migraineurs (M) and healthy controls (C) using 2-way analysis of variance with group (VS, M, C) and gender as factors. Visual evoked potentials from patients with VS demonstrated increased N145 latency (in milliseconds, VS: 152.7 ± 7.9 vs M: 145.3 ± 9.8 vs C: 145.5 ± 9.4; F = 3.28; p = 0.046) and reduced N75-P100 amplitudes (in microvolts, VS: 7.4 ± 3.5 vs M: 12.5 ± 4.7 vs C: 10.8 ± 3.4; F = 3.16; p = 0.051). Dunnett post hoc analysis was significant for all comparisons between VS and controls. These findings are in agreement with the idea that the primary disturbance in VS is a dysfunction of the visual association cortex. Ann Neurol 2018;84:946-949.

© 2018 American Neurological Association.

PMID: 30383334 DOI: 10.1002/ana.25372

Alterations in Regional Cerebral Blood (RCBF) in Visual Snow Assessed Using Arterial Spin-Labelled (ASL) Functional Magnetic Resonance Imagining (FMRI)

https://journals.sagepub.com/doi/full/10.1177/0333102418801648#_i29

Alterations in Regional Cerebral Blood (RCBF) in Visual Snow Assessed Using Arterial Spin-Labelled (ASL) Functional Magnetic Resonance Imagining (FMRI)

Experimental research
MTIS2018-153
ALTERATIONS IN REGIONAL CEREBRAL BLOOD (RCBF) IN VISUAL SNOW ASSESSED USING ARTERIAL SPIN-LABELLED (ASL) FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI)
F. Puledda1,*, F. Zelaya2, C. Schankin3 and P. J. Goadsby1

Conclusion: Patients with visual snow present significant increase in blood flow in various brain regions, namely the cerebellum, cuneus, precuneus, insula, occipital and parietal cortices, both at baseline and when subject to a visual stimulus simulating the snow itself.

This study suggests that measures of regional CBF using ASL may provide a sensitive surrogate marker of differences in resting state neuronal activity, in subjects who experience visual snow syndrome. These results are consistent with those reported in previous investigations using Positron Emission Tomography.

Visual snow syndrome: what we know so far

Perhaps the most important unmet need for the condition is a sufficient understanding of it to generate and test hypotheses about treatment.

https://journals.lww.com/co-neurology/Abstract/2018/02000/Visual_snow_syndrome___what_we_know_so_far.9.aspx

https://www.ncbi.nlm.nih.gov/pubmed/29140814

Visual snow syndrome: what we know so far.
Visual snow syndrome: what we know so far

Current Opinion in Neurology: February 2018 – Volume 31 – Issue 1 – p 52–58
doi: 10.1097/WCO.0000000000000523
NEURO-OPHTHALMOLOGY AND NEURO-OTOLOGY: Edited by José-Alain Sahel, Michael Strupp and David Zee
Abstract
Author Information
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Purpose of review We provide an overview of the neurological condition known as visual snow syndrome. Patients affected by this chronic disorder suffer with a pan-field visual disturbance described as tiny flickering dots, which resemble the static noise of an untuned television.

Recent findings The term ‘visual snow’ has only appeared in the medical literature very recently. The clinical features of the syndrome have now been reasonably described and the pathophysiology has begun to be explored. This review focuses on what is currently known about visual snow.

Summary Recent evidence suggests visual snow is a complex neurological syndrome characterized by debilitating visual symptoms. It is becoming better understood as it is systematically studied. Perhaps the most important unmet need for the condition is a sufficient understanding of it to generate and test hypotheses about treatment.

Antagonistic Relationship Between VEP Potentiation and Gamma Power in Visual Snow Syndrome

https://onlinelibrary.wiley.com/doi/abs/10.1111/head.13231

Antagonistic Relationship Between VEP Potentiation and Gamma Power in Visual Snow Syndrome.
Luna S1, Lai D1, Harris A1,2.
Author information
Abstract
OBJECTIVE:
Using a “double-pulse” adaptation paradigm, in which two stimuli are presented in quick succession, this study examines the neural mechanisms underlying potentiation of the visual evoked potential (VEP) in visual snow syndrome.

BACKGROUND:
Visual snow is a persistent visual disturbance characterized by rapid flickering dots throughout the visual field. Like the related condition of migraine with aura, visual snow has been hypothesized to arise from abnormal neuronal responsiveness, as demonstrated by a lack of typical VEP habituation to repeated visual stimulation. Yet the exact neural mechanisms underlying this effect remain unclear. Previous “double-pulse” experiments suggest that typical VEP habituation reflects disruptive gamma-band (50-70 Hz) neural oscillations, possibly driven by inhibitory interneurons. Given that migraine has been associated with reduced cortical inhibition, we propose here that visual snow may likewise reflect diminished inhibitory activity, resulting in decreased gamma power following initial visual stimulation and concomitant potentiation of the subsequent VEP response.

METHODS:
We compared VEP responses to double-pulse adaptation in a 22-year-old man with a 2-year history of visual snow versus a group of age- and gender-matched controls (N = 5). The patient does not have a comorbid diagnosis of episodic migraine or migraine with aura, and controls had no personal or family history of migraine.

RESULTS:
In contrast to the pattern of habituation observed in controls, visual snow was associated with persistent potentiation of the VEP response. Consistent with our predictions, time-frequency analysis revealed reduced gamma-band power following the initial stimulus in visual snow relative to controls.

CONCLUSIONS:
These results support an antagonistic interplay between gamma power and rapid neural adaptation, shedding new light on the neural mechanisms of VEP potentiation in visual snow.

© 2017 American Headache Society.

KEYWORDS:
P100 response; double-pulse adaptation; event-related potentials; time-frequency analysis

PMID: 29193050 DOI: 10.1111/head.13231

Visual Snow Syndrome and Its Relationship to Tinnitus

http://www.tinnitusjournal.com/articles/visual-snow-syndrome-and-its-relationship-to-tinnitus.html

https://www.ncbi.nlm.nih.gov/pubmed/28723606

Int Tinnitus J. 2017 Jun 1;21(1):74-75. doi: 10.5935/0946-5448.20170014.
Visual Snow Syndrome and Its Relationship to Tinnitus.
Renze M1.
Author information
Abstract
Visual snow is a symptom described as the continuous perception of tiny flickering dots in the entire field of vision, similar to static of an analog television. Visual snow syndrome is a cluster of symptoms found highly prevalent in patients that present with visual snow. While most of these symptoms appear to be visual in nature, approximately 63% of patients studied also report continuous bilateral tinnitus. The high correlation of visual-snow-syndrome patients presenting with tinnitus suggests that they may share a common underlying pathophysiology.

KEYWORDS:
tinnitus; visual snow; visual snow syndrome

PMID: 28723606 DOI: 10.5935/0946-5448.20170014

Visual Snow: a Potential Cortical Hyperexcitability Syndrome

https://link.springer.com/article/10.1007%2Fs11940-017-0448-3

By initiating drug treatments with low doses and slowly increasing over 1 to 4 weeks, tolerability and compliance improves and allows patients to realize the full benefits of treatment. The proposed mechanisms of microstructural cortical abnormalities and hyperexcitability as a cause of VS may lead to new treatment approaches in the future. Until such a time, medications reported to relieve persistent visual phenomena of migraine and visual aura of migraine are treatment options worth considering and these are reviewed for that purpose. Although clinical trials for the treatment of visual snow are lacking due to the rarity of the disorder, medications reviewed here should be considered for use in patients with VS who experience an impact on their quality of life. Theoretical mechanisms that lead to cortical hyperexcitability are being investigated and could lead to new treatment options. In the meantime, medications may provide benefits in this disabling condition.

Visual Snow Forum – Tapatalk

https://www.tapatalk.com/groups/thosewithvisualsnow/discussion/all

Original Visual-Snow or Static forum

https://donate.visualsnowinitiative.org/o/en/campaign/visualsnowinitiative

The visual snow phenomenon

https://www.ncbi.nlm.nih.gov/pubmed/25440184

https://www.sciencedirect.com/science/article/pii/S0181551214002678?via%3Dihub

[The visual snow phenomenon.]

J Fr Ophtalmol. 2014 Nov;37(9):722-727. doi: 10.1016/j.jfo.2014.08.001. Epub 2014 Oct 14.
[The visual snow phenomenon.] [Article in French] Zambrowski O1, Ingster-Moati I2, Vignal-Clermont C3, Robert MP4.
Author information
Abstract
INTRODUCTION:
Visual snow is a symptom described by some patients and poorly recognized by ophthalmologists. It consists in the permanent perception of a textured or a snowy vision, sometimes associated with palinopsia, exaggerated perception of the blue field entoptic phenomenon and photophobia. We report a group of patients suffering from visual snow in order to precise its characteristics and discuss its pathophysiology.

MATERIALS AND METHODS:
Prospective study of patients diagnosed between September 2010 and December 2012 with a visual snow phenomenon. For each patient, a formal ophthalmologic examination, an Amsler grid test, an automated visual field (central 20°), a color vision test (15 Hue), a full field, a pattern and a multifocal electroretinogram as well as flash and pattern visual evoked potentials (Métrovision©) were performed. A brain imaging was not systematically performed.

RESULTS:
Twelve patients aged 9-48old were included (six men and six women, 85 % of students). Several signs were variably associated with the visual snow phenomenon: palinopsia (50 %), constant blue field entoptic phenomenon (40 %), photophobia (30 %), migraine (30 %); in 20 % of cases, an initial toxic intake was found (20 %).

DISCUSSION:
This study highlights the reproducibility of typical symptoms described by patients reporting the visual snow phenomenon. This feature strongly supports the organic origin of the phenomenon. The pathophysiology of this phenomenon, however, remains unclear; the hypothesis of a lower threshold for perception of entoptic images cannot entirely account for the reported symptoms.

Copyright © 2014 Elsevier Masson SAS. All rights reserved.

KEYWORDS:
Entoptic phenomenon; Migraine; Neige visuelle; Palinopsia; Palinopsies; Photopsia; Photopsies; Phénomène entoptique du champ bleu; Snow vision

PMID: 25440184 DOI: 10.1016/j.jfo.2014.08.001

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