Homonymous Hemianopsia as the Presenting Sign of Migrainous Infarction

Migraine is a clinical diagnosis. Occasionally, unusual presentations make migraine a diagnosis of exclusion, where imaging is required to rule out structural pathologies before the diagnosis of a migraine can be made. This condition presents a great diagnostic challenge for clinicians because the pathophysiology is not entirely clear, and evaluation of a migrainous infarction upon initial presentation lacks nuance. In typical migraine headaches, visual field phenomena are temporary, unlike the case presented here where persistent visual field loss should prompt neuroimaging.