Affiliations: Department of Neurology, Showa University School of
Medicine, Japan | Department of Engineering, Chiba University,
Japan | The Japan Society for the Promotion of Science,
Japan | CREST, JST, Japan
Note: [] Corresponding author: Shinichi Koyama, Department of Neurology,
Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo
142-8666, Japan. Tel./Fax: +81 3 3784 8710; E-mail: skoyama@med.showa-u.ac.jp
Abstract: We report a patient who has had persistent visual disturbances since
she underwent catheter ablation to treat her Wolff-Parkinson-White (WPW)
syndrome. We examined her visual symptoms carefully and quantitatively by means
of our newly developed method combining image-processing and psychophysics. We
first simulated the patient's visual symptoms using image-processing
techniques. Since the simulation indicated that she would be very sensitive to
the edges of the visual stimuli, we evaluated her sensitivity to the edges
using psychophysics. The results indicated that she was hypersensitive to the
clear-cut edges of the visual stimuli. Her visual symptoms were very similar to
those of visual aura of migraine, rather than those of photosensitive epilepsy.
Magnetic resonance imaging (MRI) and single photon emission computed tomography
(SPECT), electroenchepalogram (EEG), and visual-evoked potentials (VEP) in the
patient were normal. No abnormalities in her fundus, visual field, or
electroretinogram were found, either. Transesophageal echocardiography with
bubble study indicated that she had a preexisting right-to-left shunt. We
hypothesize that visual aura of migraine was triggered and made persistent by
the catheter ablation in this patient. Although the relationship between
migraine, catheter ablation, and right-to-left shunts is unknown, previous
studies on the transcatheter closure of patent foramen ovale suggest a possible
link between them. Catheter ablation in patients with migraine and preexisting
shunts may lead to exacerbations in migraine symptoms.
