Stereotyped visual aura as early manifestation of a relapsed breast cancer with isolated brain metastasis

Breast cancer brain metastasis often leads to various ocular symptoms. We herein present a case in which an intermittently stereotyped visual aura served as the initial presentation of isolated brain metastasis in a patient with breast cancer in remission. No one has previously reported this unusual presentation. The patient, a 40-year-old woman with a history of Stage 3 breast carcinoma, presented one year after her initial diagnosis with a complaint of intermittent visual disturbances in the left side of her visual field in both eyes for three months. The symptoms consisted of intermittent episodes of flashing lights in a zig-zag pattern within her left lower visual field. Each episode lasted several minutes, with complete resolution between them. Initially, these episodes occurred 2–4 times per week, but over time, they became more frequent, eventually resulting in a persistent visual field loss. An eye examination revealed a dense left homonymous quadrantanopia. Magnetic resonance imaging revealed an enhanced, heterogeneous mass in the right occipital lobe. Surgical excision confirmed a metastatic carcinoma originating from the breast. Despite stereotactic radiosurgery, the visual field defect persisted for more than a year. This case highlights the importance of recognizing stereotyped visual auras as potential indicators of metastatic tumour involvement in the visual pathway.