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Ghormeh Sabzi

Visual Snow: A New Disease Entity Distinct from Migraine Aura

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[s36.006] Visual Snow: A New Disease Entity Distinct from Migraine Aura

Christoph Schankin, Farooq Maniyar, Jan Hoffmann, Denise Chou, Peter Goadsby, San Francisco, CA

OBJECTIVE: To define clinical criteria for visual snow. BACKGROUND: Visual snow is a disorder with continuous visual symptoms consisting of white and black dots in the entire visual field that can persist for years. Additional visual phenomena might be present. It has a major impact on patients' quality of life. The literature confounds the condition with persistent visual aura in migraine. Treatment usually fails. Physicians may regard the problem is trivial or psychogenic. DESIGN/METHODS: Retrospective survey of patients with visual snow. We describe the clinical phenotype of affected patients and propose criteria for the diagnosis. RESULTS: Patients (n = 120) with a female:male ratio of 1:2.2 are reported. Mean age of onset was 16.8±10.9 years with a mean duration of 9.1±10.3 years. Of patients 106 (88%) had visual snow during the daytime and 117 (98%) at night. Additional visual symptoms were: floaters (73%), persistent after-images (63%), "hard time seeing at night" (58%), "little cells that travel on a wiggly path" (57%), photophobia (54%), "moving objects leave trails" (48%), flashes (44%), and "swirls with eyes closed" (41%). Most disturbing were visual snow, floaters and "hard time seeing at night". Of patients 92% had no response to medication. Substance abuse was present in 40% of patients (LSD in 5%). Requiring at least one, two or three of the additional visual symptoms to make the diagnosis reduced the sensitivity by 3%, 10% and 21%. All standard tests were normal. CONCLUSIONS: (i) Visual snow, or Positive Persistent Visual Disturbance, is a unique disease entity presenting clinically distinct from migraine with aura.

(ii) Criteria are: visual snow during daytime or at night plus at least one of the following: floaters, persistent after-images, "hard time seeing at night", "little cells that travel on a wiggly path", photophobia, "moving objects leave trails", flashes, and "swirls with eyes closed".

(iii) Currently, the etiology is unknown. Supported by: Deutsche Forschungsgemeinschaft SCHA 1676/1-1.

Category - Headache: Clinical presentation/diagnosis

Wednesday, April 25, 2012 5:15 PM

Session S36: Headache II (4:00 pm-5:30 pm)

http://www.abstracts2view.com/aan/view.php?nu=AAN12L_S36_006&terms=

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Dr. Goadsby has seen a few patients with HPPD symptoms in his time and a leading researcher for Headaches. I like his phrase for the syndrome, and also pointing out interesting quantitative data here.

Thanks for posting!

David

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its interesting how many people have hppd symptoms compared to how many people had previous drug use :S

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somone posted this recently on the vsforum:

http://www.medpageto...ANMeeting/32416

dont know what you are thinking about this, but in my opinion there are a few inconsistencies between this and the abstract?!

Overall, of the 57 with the classic visual snow, nearly all reported at least one additional symptom and 93% had at least three.

Most could recall the exact day that the disturbances began and what they were doing at the time, Schankin said. Only three said they had taken illicit drugs -- marijuana, with one reporting psychedelic mushrooms, and another having taken cocaine and amphetamines as well -- within seven days before onset.

abstract:

Substance abuse was present in 40% of patients (LSD in 5%)

does this mean he only is not aware of the possibility of a delayed onset of HPPD?

furthermore:

But more than half (54%) said they also had migraines, with two-thirds of those accompanied by aura. On the other hand, Schankin said the condition appears distinct from migraine aura even in those individuals

if you add 54% withmigraine history plus the 40% of the abstract you get 94% so maybe 6% developed it by an unknown etiology(not PMA or HPPD)?!

Note that this survey indicates that visual snow, a condition of unknown etiology, is distinct from migraine and consists of persistent floaters and after-images that fill the visual field. The conditions does not interfere with vision but does impact negatively upon quality of life.

i am curious how he will prove that it is distinct from migraine

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