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What Is Scintillating Scotoma?

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Have you ever heard about scotomas? Or are you experiencing scintillating Scotoma? The topic is unique, and I hope you will go through the entire article to understand the topic thoroughly.

What Does Scotoma Means?

scintillating scotoma cause

A scotoma is a localized area of partial visual disturbance in the visual field. Besides, Scotomas are the visual aura that begins from the age of 30 and represents neuronal dysfunction of the brain’s visual cortex. Similarly, each Scotoma consists of two parts, positive and negative. Firstly, the positive part is filled with black and coloured flickers. Secondly, the negative part is scattered in the periphery of your visual field. (1)

What Are Scintillating SCOTOMA And Visual aura?

scintillating scotoma treatment

The blind spot, flicker, or waver in your visual field may blur your vision, and you will assume it a dust particle when you see or focus on an object. Therefore, scintillating Scotoma is also termed flickering Scotoma, flittering Scotoma, fortification spectrum, and fortification figure. Furthermore, Scintillating Scotoma is a type of visual aura which is an umbrella term that represents the electrical and chemical running through the visual cortex of the brain. (1)

CLinical Presentation Of Flickering Scotoma/ Visual aura

The presentation of flickering scotoma/ Visual aura may vary depending upon the underlying cause, but the essential sign and symptoms are mutual for all. 

  1. NEUROLOGICAL SIGN AND SYMPTOMS
  • CONFUSION
  • DISORIENTATION 
  • DIZZINESS
  • HEADACHE
  • MIGRAINE
  • BLINDSPOT
  • SLURRED SPEECH
  • NUMBNESS AND ALSO TINGLING
  • MUSCULAR WEAKNESS
  1. OTHER SIGN AND SYMPTOMS
  • EYE PRESSURE AND SORENESS
  • NAUSEA/ VOMITING (2)

Scintillating Scotoma is the earliest symptom of Multiple sclerosis because inflammation of the optic nerve and surrounding cascading pressure will lead to a visual aura. Nevertheless, if you are experiencing scintillating Scotoma, it does not surely mean that you fall in the category of multiple sclerosis as visual aura also appears in other neurological disorders. (3)

Causes

  1. PRIMARY CAUSES

Firstly, the primary causes are the vascular changes in the calcarine artery and the parts supplied by it, abnormal electrical activity running in some regions of the brain. Additionally, hormonal changes resulting in subsequent effects in visual and other related functions.

Secondary Causes And Risk Factors Econdary Causes And Risk Factors Of Visual Scotoma

  1. Macular degeneration
  2. Exposure to the high power Laser beam
  3. Pregnancy
  4. Eclampsia and pre-eclampsia
  5. Epilepsy
  6. Seizure disorder
  7. Furthermore, mental stress, anxiety, and depression
  8. Neurological Infections
  9. Food allergy
  10. Glaucoma
  11. Also, can cause Multiple sclerosis and Neurodegenerative disorders
  12. Cerebrovascular accident/stroke
  13. Traumatic brain injury (TBI)/ Migraine

Therefore, Research studies concluded that 25% of pregnant women experience visual aura as the earliest sign of hypertension. Whereas, Scintillating Scotoma is most common in pregnancy. Also,you may experience visual aura at least once during your whole nine months of conception; as hormonal changes will trigger visual symptoms during pregnancy. Thus, be cautious and do not ignore any of the symptoms of flickering Scotoma during pregnancy. Because, it may be the first sign of pre-eclampsia or hypertension. (4) (5)

Diagnosis And Diagnosis Tools

Diagnosis can be made by thorough ophthalmic examination.

Subjective examination

It can be verified subjectively by closing one eye and focus on an object with another eye by holding a reference object in front of it in the horizontal and lateral visual eye fields and emphasize your symptoms. Furthermore, the most probable size of the visual aura will be about 5×7 degrees of visual angle. 

Ophthalmic examination

Your healthcare practitioner will do further specific and concerned ophthalmic examination with an ophthalmoscope. (6)

Management

So, In most cases, scintillating Scotoma symptoms will go away on their own within an hour and without any medical treatment by drinking water, closing the eyes, and having sufficient rest.

  1. MEDICAL MANAGEMENT

 Treatment is specific to the underlying cause

  1. CONSERVATIVE 

Irrespective of the cause, your healthcare practitioner may prescribe you the following over-the-counter medications as per need.

Anti-depressants

Anti-epileptics

Opioid analgesics

Beta-blockers

  1. NON-CONSERVATIVE

Non-Conservative treatment is not usually indicated only to resolve symptoms of a scintillating scotoma. Underlying triggers such as TBI and stroke may need surgical intervention. (7)

  1. PHYSIOTHERAPY MANAGEMENT

Do eye exercises in H-manner

Also, keep on doing convergence and divergence eye exercises

Figure 8 exercise is also important

And do a 20-20-20 rule exercise

Pencil push-ups exercise

Barrel cards exercise

Broke strong exercise

Prognosis

The prognosis depends upon several factors, particularly age. Similarly ,if you got scintillating Scotoma in the early stage of life; it could be lethal. But if you experience a visual aura in the later stage of life; so the prognosis is good. (8)

Safety Measures

  • Stay hydrated
  • Avoid smoking and alcohol
  • Do not drive when you are going through an attack of visual Scotoma
  • Further, stop using gadgets (mobile, computer, etc.); when you encounter an episode of Scotoma
  • Avoid psychological health barriers (depression, anxiety, and stress)
  • Keep calm and also relax
  • Certainly, have a good sleep habit 
  • Likewise, add plenty of fruits and vegetables to your diet 
  • Gentle exercise and a brisk walk must be on your daily roster
  • Furthermore, avoid self-administration of over-the-counter medications. Above all. always follow the treatment plan prescribed by your healthcare practitioner. (9)

Conclusion

In other words, Scintillating Scotoma may be a momentary or longstanding visual-perceptual cortical defect; that occurs during migraine. However, Visual aura can be confused with an ocular migraine. Although scintillating Scotoma often occurs with headaches in younger. While adults after the age of 50 may not experience headache migraines.

Certainly, Scintillating Scotoma is a benign, non-lethal condition. But the underlying cause could not be ignored to root out the etiology.

Lastly, If your symptoms get worst immediately, consult with your healthcare practitioner. So, he will determine whether your clinical signs and symptoms cause concern.

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