Brain Advance Access originally published online on January 30, 2007
Brain 2007 130(6):1690-1703; doi:10.1093/brain/awl348
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exploring the visual hallucinations of migraine aura: the tacit contribution of illustration
National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
Corresponding to: G D Schott, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. E-mail: geoffrey.schott{at}uclh.nhs.uk
The visual aura of migraine is a subjective phenomenon, and what the migraineur experiences is necessarily inaccessible to others. Fortunately, however, the sufferer can occasionally reveal what is being seen by means of graphic representation, enabling an otherwise closed ‘window’ to be opened on the transiently dysfunctioning brain. This article explores the unique contribution that illustration has made to understanding mechanisms subserving the visual aura. The most revealing illustrations are those made by the very few scientists who have recorded and analysed the scotomas, and in particular the expanding fortification spectra, experienced during their migraine attacks. It is solely through illustrations such as these that the uniform nature of many of these hallucinations has been demonstrated. As a result, it follows that there is likely to be a similarly uniform repertoire of processes that generate the hallucinations in the occipital cortex. The precise form of the zigzags that comprise the fortification spectrum, their shimmering appearance, and in particular the speed of the peripheral spread, all of which are entirely dependent on graphic display for their elucidation, enable conclusions to be reached about a number of the underlying pathophysiological mechanisms, including the involvement of spreading cortical depression, that likely occur. Illustration has been pivotal too in revealing uncommon and sometimes curious, if not bizarre, visual hallucinations, the forms of which suggest that extrastriate and temporal lobe involvement contributes to migraine aura in some instances. Illustration can also be valuable in differential diagnosis, depicting other forms of visual hallucination which result from a variety of non-migrainous causes. Illustration, particularly when made during the attack, provides an unusual, little used but powerful tool which uniquely allows the sufferer's subjective visual experiences to inform objective analysis. In turn, this analysis leads to insights into some of the cerebral disturbances which subserve migraine aura.
Key Words: illustration; hallucination; visual aura; migraine
Received October 6, 2006. Revised November 12, 2006. Accepted November 15, 2006.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. P. Panayiotopoulos, M. Michael, S. Sanders, T. Valeta, and M. Koutroumanidis Benign childhood focal epilepsies: assessment of established and newly recognized syndromes Brain, September 1, 2008; 131(9): 2264 - 2286. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Migraine Aura Illustrations May Illuminate Their Physiology Journal Watch Neurology, August 7, 2007; 2007(807): 4 - 4. [Full Text]
|
|