Right Occipital Arteriovenous Malformation presenting as a Migraineous Visual Aura

Migraine with visual aura is a distinct entity from a migraineous visual aura. A migraine with visual aura is characterized by a visual aura that does not prefer either visual field and accompanies a headache. The mechanism of the visual aura is via cortical spreading depression. A migraineous visual aura is secondary to an underlying focal structural brain abnormality and therefore always involves the same side. We aim to highlight this distinction through the following presentation on a patient with recurrent right-sided headaches and left-sided visual auras for 32 years, found to have a right occipital arteriovenous malformation eventually leading to a permanent left-sided macula-sparing homonymous hemianopsia.