Recurrent migraine with binocular transient vision loss associated with acute stroke: A case report

INTRODUCTION: Amaurosis fugax (AF) refers to monocular transient vision loss (TMVL) or binocular transient vision loss (TBVL). TBVL is less common than TMVL and may be due to cortical lesions. TVL can be associated with stroke and thus merits urgent evaluation. Here, we report a case of recurrent migraine associated with TBVL in an adult patient. CASE PRESENTATION: A 45-year-old male presented at the eye clinic complaining of an acute episodic of TBVL lasting three consecutive days with complete spontaneous recovery. He had a history of hypertension with blood pressure 143/94 mmHg. While in the clinic, he experienced a TVL attack that persisted for 5 min. We immediately referred him to the hospital for a magnetic resonance angiogram (MRA) scan and laboratory workup. While waiting for the examination results the next day, the patient had a seizure and became unconscious. He was admitted to the emergency room and then to the intensive care unit (ICU). The MRA showed post-hemorrhagic encephalomalacia in the internal capsule's right basal ganglia/right anterior limb. Fundoscopy showed an empty vessel and cotton-wool spots, which were consistent with hypertensive retinopathy. The patient was diagnosed with bilateral AF due to hemorrhagic stroke and hypertensive retinopathy. He was treated by a neurologist, and 3 days after being discharged he presented at the eye clinic with a visual acuity of 20/25 in both eyes. CONCLUSION: Recurrent migraine with TBVL can be associated with acute stroke. It thus merits urgent evaluation and referral to the relevant department for a better outcome.