6th Edition of Neurology World Conference 2026

Abstract

Background: In an older adult with a complex vascular history, transient monocular vision loss with severe unilateral eye pain, initially diagnosed with hypertensive emergency, warrants a broad differential. Distinguishing between vascular, neuro-ophthalmic, and migraine etiology is imperative, as each requires a different approach to management. Case Presentation: A 66-year-old woman with coronary artery disease post-CABG, bilateral carotid endarterectomies, hypertension, hyperlipidemia, and migraine presented with sudden severe left eye pain and transient left eye blurry vision. Blood pressure was 239/121. Physical examination showed no temporal tenderness, no pain with eye movement, normal pupils, and normal funduscopic findings. Non-contrast head CT, CTA neck, and chest X-ray were unremarkable. CTA head showed a 3 mm right ACA aneurysm without large-vessel occlusion. CT venogram was negative for venous sinus thrombosis. EKG showed normal sinus rhythm, and serial troponins were negative. She received IV morphine with mild relief and was admitted to the ICU for hypertensive emergency, started on IV nicardipine. During ICU admission, her blood pressure improved, and blurry vision resolved. However, severe left eye pain persisted, radiating in the V2 distribution. She reported intermittent left eye pain for one month, previously evaluated by ophthalmology with a normal exam. Neurology favored ocular migraine given her history and normal ophthalmology evaluation. A migraine cocktail of ketorolac, prochlorperazine, diphenhydramine, and IV fluids, resolved her symptoms completely. Discussion: The patient's symptoms, normal ophthalmologic exam and imaging, and rapid response to migraine-directed therapy supported a diagnosis of ocular migraine concomitant with hypertensive emergency. Retinal migraine, a rare entity, is characterized by brief episodes of monocular visual disturbance with a unilateral headache ipsilateral to the side of vision loss likely from retinal vasospasm. Conclusion: More studies are needed to better investigate the occurrences and associated risk factors of ocular migraine.