Вербальна алексія — аура тихої мігрені: аналіз клінічного випадку

This article presents current insights into the pathophysiological mechanisms and clinical manifestations of silent migraine, a subtype of migraine in which patients experience an aura without the subsequent headache phase. A literature review suggests that silent migraine can occur at any age but is more prevalent in older women. Its pathophysiology closely resembles that of classical migraine. The leading hypothesis proposes that migraine aura arises from a spreading wave of depolarization across neuronal and glial cell membranes in the cerebral cortex. This wave propagates from the occipital cortex to the somatosensory and frontotemporal regions, accompanied by disturbances in regional cerebral blood flow, leading to cerebral hypoperfusion and the development of various aura symptoms. Literature reports indicate that ophthalmic aura is the most common type observed in silent migraine, characterized by both positive and negative visual symptoms. This phenomenon is attributed to circulatory disturbances in the posterior cerebral artery territory and typically presents as homonymous visual field defects without headache. It is believed that silent migraine shares the same provoking factors as classical migraine, but patients may not always recognize or accurately identify these triggers.This article presents a clinical case of a silent migraine attack triggered by lens replacement surgery in the right eye of an older female patient with cataract. The patient had been experiencing migraine for ten years, consistently presenting with an ophthalmic aura without headache, characterized by brief (20­minute), stereotypical positive visual symptoms in the form of bright, shimmering zigzags. The silent migraine attack occurred the day after surgery, during which the patient’s usual aura symptoms were accompanied by prolonged negative symptoms, including visual field defects and simultaneous optical agnosia in the form of verbal alexia. The findings suggest that the surgical intervention served as a strong trigger for an atypical silent migraine episode in this patient.