K 279Migraine with accompanying ocular symptoms associated with APC resistance
T. Büchner, U. Schnorbus, I. Husstedt, H. Gerding
Background: APC resistance due to factor V Leiden mutation is the most common genetic cause of thrombophilia in Europe (3-7% of the population). Carriers have an increased risk of venous thromboembolism. The role of this defect in arterial or microvascular ischemia is still not known.
Case report: We examined a 27 year-old female with a 16 year history of migraine and visual field defects in her left eye for 2 weeks.
Visual acuity was 20/20 on both eyes. Slit lamp examination, pupillary reflexes, ophthalmoscopy, fluorescein angiography and VEP were unremarkable. Therapy with flunaricin for migraine was started and visual fields deteriorated in both eyes over a period of 4 weeks. Neurologic, radiologic (MRI) and doppler ultrasonographic examinations were unremarkable. The ERG showed a slight asymmetry in cone and rod recordings and a clear difference between both eyes in the oscillatory potentials (symmetrical 8 years ago).
The patient was found to be heterozygous for factor V Leiden mutation (G1691A). Therapy with coumarin was instituted at INR 2.0-3.0 and no further deterioration occured.
Conclusion: This patients medical history suggests a possible role of APC resistance in the pathogenesis of these 2 symptom complexes: Both the migraine and the persistent bilateral visual field defects atypical for migraine could be effects of the hypercoagulability.
Augenklinik der Westfälischen Wilhelms-Universität, Domagkstraße 15, D-48149 Münster