Visual snow

Visual snow
Animated example of visual snow-like noise
Classification and external resources
ICD-10 Xxx.x
ICD-9-CM xxx

Visual snow, visual static, or persistent visual snow is a transitory or persisting medical disorder in which sufferers see snow or television-like static in parts or the whole of their visual fields, constantly in all light conditions, even visible in daylight, darkness and with closed eyelids. The severity or density of the "snow" differs from one person to the next; in many circumstances, the condition negatively affects daily life, making it difficult or impossible to read, drive, perform routine tasks, see in detail (even in bright daylight) or focus correctly because of afterimages and numerous other visual and non-visual co-morbidities, as discussed below. Indeed, medical literature refers to the condition as "disabling" and "debilitating." The use of computer screens can exacerbate symptoms considerably in many patients. Also see Closed eye hallucination: Level 1, which makes people aware that they start to notice it even in normal situations, because what-ever is visible in the dark will be visible on any color plain surface.

Little is known about this rare condition, and it has conventionally been regarded as a variant of migraine aura—though recent research shows this is not the case. It is commonly confused with floaters by opticians and doctors alike when patients describe their symptoms, leading to misdiagnosis as well as underdiagnosis of visual snow. At times, if it is visible on certain surfaces it can be because our eyes sees vitreous fluid present inside our eyes (entopic phenomenon). In some cases, it can be vitreous degeneration.

Visual snow is now regarded as a unique syndrome—usually presenting with other symptoms, such as persistent afterimages, photophobia, enhanced blue field entoptic phenomenon and tinnitus.[1]

Recent research has confirmed a brain hypermetabolism in persons with visual snow, located principally in the right lingual gyrus.[2] Before this, no other cause for visual snow had been identified. Insofar as sufferers of visual snow had undergone ophthalmic, neurological and psychiatric examinations, no systematic problems besides the visual snow were found. The recent research that indicates this disorder occurs in the brain has important ramifications for the possibility of potential treatment. However, standard treatment protocols have yet to be established.

Signs and symptoms

In addition to visual snow, many of those affected have other types of visual disturbances such as starbursts, increased afterimages, floaters, trails, and many others.[3]

Non-visual symptoms such as ringing in the ears, depersonalization-derealization, fatigue, speech difficulties and cognitive dysfunction (brain fog) are frequently encountered. Secondary psychiatric sequelae such as anxiety, panic attacks or depression may develop due to lack of answers and general ignorance of the condition in medical practice.

Causes

In May 2014 the results from the first major research trial into visual snow were reported.[4] The study described strong evidence from positron emission tomography scans that the disorder is associated with hypermetabolism in the right lingual gyrus and left cerebellar anterior lobe of the brain. The researchers stated that pinpointing visual snow (and its related symptoms such as afterimages) to a functional problem in a specific brain area may open up possibilities for targeted treatment and that treatment trials will follow.

Visual snow can occur in a variety of ophthalmic conditions that can be diagnosed by the presence of additional clinical signs and experiences.

Persisting visual snow can feature as a leading addition to a migraine complication called persistent aura without infarction,[5] commonly referred to as persistent migraine aura (PMA). It is important to keep in mind that there exist many clinical sub-forms of migraine where headache may be absent and where the migraine aura may not take the typical form of the zigzagged fortification spectrum, but manifests with a large variety of focal neurological symptoms.

A condition that sometimes produces visual snow is optic neuritis (inflammation of the optic nerve). Moreover, a variety of illnesses (e.g., Lyme disease, auto-immune disease) or noxious events (dehydration) have been blamed by sufferers in self-help internet forums as causes of persisting visual snow, but none of these claims have been confirmed by scientific study. However, Lyme Disease has been shown to cause optic neuritis.[6] Some patients fail to find any apparent causative illness or event in their lives, instead saying the snow came out of nowhere or has been with them for their whole lives.

The role of hallucinogens in the etiology of visual snow is not entirely obvious. Hallucinogen persisting perception disorder (HPPD), a condition caused by hallucinogenic drug use, is sometimes linked to visual snow,[7] but both the connection of visual snow to HPPD[8] and the etiology and prevalence of HPPD is disputed.[9] Most of the evidence for both is generally anecdotal, and subject to spotlight fallacy.[8][9]

Diagnosis

Proposed diagnostic criteria for the "visual snow" syndrome:[10]

Comorbidities

Migraine and migraine with aura are common comorbidities. However, comorbid migraine worsens some of the additional visual symptoms and tinnitus seen in "visual snow" syndrome. This might bias research studies by patients with migraine being more likely to offer study participation than those without migraine due to having more severe symptoms. In contrast to migraine, comorbidity of typical migraine aura does not appear to worsen symptoms.[4]

Treatments

There is no established treatment for visual snow.

In HPPD, clonazepam has been recommended as medication of first choice in patients seeking medical help.[11] In persistent aura without infarction, the evidence so far suggests that acetazolamide may be the premier drug for patients with the repetitive form of aura status[12] and that valproate,[13] lamotrigine,[14] or topiramate[15] should be first choices for patients with the continuous form. When these oral drugs are ineffective, an intravenous injection or injections of furosemide should be tried.[16]

See also

References

  1. ↑ Schankin, CJ, Maniyar, FH, Digre, KB, Goadsby, PJ (2014) ‘Visual snow’ – a disorder distinct from persistent migraine aura, Brain doi:10.1093/brain/awu050
  2. ↑ Schankin, Christoph J.; Maniyar, Farooq H.; Sprenger, Till; Chou, Denise E.; Eller, Michael; Goadsby, Peter J. (2014-06-01). "The Relation Between Migraine, Typical Migraine Aura and "Visual Snow"". Headache: The Journal of Head and Face Pain. 54 (6): 957–966. doi:10.1111/head.12378. ISSN 1526-4610.
  3. ↑ Podoll K, Dahlem M, Greene S. Persistent migraine aura symptoms aka visual snow.
  4. 1 2 Schankin, CJ, Maniyar, FH, Sprenger, T, Chou, DE, Eller, M, Goadsby, PJ, 2014, The Relation Between Migraine, Typical Migraine Aura and "Visual Snow", Headache, doi:10.1111/head.12378
  5. ↑ International Headache Society. The International Classification of Headache Disorders, 2nd edition" Cephalalgia 2004; 24 (suppl. 1): 1-160.
  6. ↑ http://www.nationalmssociety.org/Symptoms-Diagnosis/Other-Conditions-to-Rule-Out/Lyme-Disease
  7. ↑ Abraham HD (1983). "Visual phenomenology of the LSD flashback". Arch Gen Psychiatry. 40: 884–889. doi:10.1001/archpsyc.1983.01790070074009.
  8. 1 2 Schankin, C.; Maniyar, F.; Hoffmann, J.; Chou, D.; Goadsby, P. (22 April 2012). "Visual Snow: A New Disease Entity Distinct from Migraine Aura (S36.006)". Neurology. 78 (Meeting Abstracts 1): S36.006–S36.006. doi:10.1212/WNL.78.1_MeetingAbstracts.S36.006.
  9. 1 2 Halpern, J (1 March 2003). "Hallucinogen persisting perception disorder: what do we know after 50 years?". Drug and Alcohol Dependence. 69 (2): 109–119. doi:10.1016/S0376-8716(02)00306-X. PMID 12609692.
  10. ↑ Schankin, Christoph; Maniyar, Farooq; Hoffmann, Jan; Chou, Denise; Goadsby, Peter (February 2013). "Clinical characterization of "visual snow" (Positive Persistent Visual Disturbance)". The Journal of Headache and Pain.
  11. ↑ Lerner AG, Kladman I, Kodesh A, Sigal M, Shufman E. "LSD-induced Hallucinogen Persisting Perception Disorder treated with clonazepam: two case reports. Isr J Psychiatry Relat Sci 2001; 38: 133-136.
  12. ↑ Haan J, Sluis P, Sluis LH, Ferrari MD (2000). "Acetazolamide treatment for migraine aura status". Neurology. 55: 1588–1589. doi:10.1212/wnl.55.10.1588.
  13. ↑ Rothrock JF. "Successful treatment of persistent migraine aura with divalproex sodium" Neurology 1997; 48: 261-262.
  14. ↑ Chen WT, Fuh JL, Lu SR, Wang SJ. "Persistent migrainous visual phenomena might be responsive to lamotrigine" Headache 2001; 41: 823-825.
  15. ↑ Podoll K, Dahlem M, Haas DC. Persistent migraine aura without infarction - a detailed description
  16. ↑ Rozen TD (2000). "Treatment of a prolonged migrainous aura with intravenous furosemide". Neurology. 55: 732–733. doi:10.1212/wnl.55.5.732.
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