Witness Post: Scintillating Scotoma
Walking in Cousler Park in West York, PA, there was a zigzag flashing light that started on the upper left of my vision and gradually began to take over major portions of my eyesight from my visual horizon. Like lightening bolts the images got more and more intense as the moments passed. I asked my brother, Charlie, if we could sit down a moment to let the light flashes pass. As someone who is accustomed to seizures, Charlie was the perfect travel companion that day; he talked me through the visual migraine that had overtaken my visual field. Only knowing the condition as a “migraine without the headache,” it was time for me to figure out what was going on with my eyes.
The crazy zigzag lines were dramatic, like a visual series of radio waves, imagined by Guglielmo Marconi. One time from his English observatory Marconi said, “scintillating discrete angels broke away from the line during its strongest period. And a well-marked stream of persistent angel echoes could be seen moving up the Thames estuary.” [1] The angels in his case were birds who interrupted the radio frequency enough to create an unusual image.
The medical term for what had happened to me is called a scintillating scotoma. In simple terms it is an aura or blank spot that obstructs part of your vision. Scintillating scotomas are blind spots that flicker and waver between light and dark as they migrate across your line of sight.
While not a long lasting or dangerous condition, scintillating scotomas are typically temporary; that said, they can be an indicator of underlying health conditions that are worth tracking.
What is a Scintillating Scotoma?
Scintillating scotomas appear as “floaters” or small blood clots that float across one’s field of vision. They can be in the shape of strings or dots, and they may appear as blind spots in your field of vision. Scotomas appear to smear and obscure what you see. They are NOT pieces of dust or dirt or lint that have landed in your eye, they are more like an electrically charged force field. Scotomas derive from the mix-up of the neurological signals being sent from your eye to your brain. These anomalies in the neurological messages to your brain cause what appear to be lightning bolts or “glitches” as you look at the world around you.
Scotomas are a type of aura, a visual phenomenon, that’s fairly common. Some describe them as a personal aurora borealis. Scintillating scotomas may look wavy or alternate growing from dark to light again. The edges of the spot you see are often jagged.
Occasionally headache pain may accompany these scintillating scotomas, other times victims say they feel no pain at all. Scintillating scotomas can happen before or during or after a migraine headache. They can also be signals of underlying health conditions such as glaucoma or multiple sclerosis (MS).[2]
What are the primary causes of Scintillating Scotoma?
Scintillating scotomas are typically caused by what’s known as cortical spreading depression. Basically, this is abnormal electrical activity moving through your brain. These electrical impulses may be related to high blood pressure, inflammation, or hormonal fluctuations, among other things.
Health conditions that scintillating scotomas are related to include: migraines with aura; visual or ocular migraines (migraines without headache pain); seizures, stroke, stress, head injury, food allergies, hypertension and pregnancy. I have never had any of these serious other conditions beyond the visual migraine. Many of my family members have the full meal-deal migraines, so I count myself as fortunate to not experience those severe headaches.
How are scintillating scotomas typically treated?
Typically, scintillating scotomas don’t require treatment. In most cases, the aura and jagged lightning bolts move from one side of the visual field to the other and the blind spot resolves itself within about an hour.
Lying down to rest, closing your eyes, drinking water, and taking an over-the-counter pain reliever, such as ibuprofen or acetaminophen, may help to relieve mild symptoms of scotomas.
Are certain people more at risk of scintillating scotomas?
Coming from a family that is prone to migraines, I wondered if there were certain traits that were also with these visual migraines. Here is what I found out:
Some people may be more at risk of developing scintillating scotoma symptoms.
If you frequently have migraines with aura, you most likely have this symptom. Risk factors for migraine with aura include family history and being assigned female at birth. Having a mental health condition, such as depression, may put you at a higher risk for scotomas.
Lifestyle-related factors, such as high blood pressure, stress, and anxiety, may also be connected to developing scotomas.
When to See a Doctor [3]
If you’re experiencing a visual disturbance, don’t try to drive or operate large machinery. If you’re able to sit down, tilt your head back, and rest, do so. The scotoma will most likely resolve on its own. Below are some symptoms that, when they occur with scintillating scotoma, will need to be addressed with the help of a medial professional. Seek medical attention right away if you experience any of the following:
- sudden, severe headache
- muscle weakness
- difficulty speaking or slurred speech
- dizziness or nausea
- headache and scotomas following an accident or injury
- numbness in your face, arms, or legs
- disorientation or mental confusion
Takeaways
Scintillating scotomas are typically benign, meaning that they aren’t a cause for concern and they go away without treatment.
Recurring scintillating scotomas can indicate other health conditions, such as migraine, glaucoma, multiple sclerosis, and preeclampsia.
Other risk factors and symptoms you have will help your doctor determine whether your scotomas are a cause for concern.
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[1] Macdonald, Helen, Vesper Flights, Gross Press, NY, 2020, page 174.
[2] https://www.healthline.com/health/scintillating-scotoma
[3] https://en.wikipedia.org/wiki/Scintillating_scotoma
Henry E. Hooper 