16 year old sudden partial loss of vision - advice

[thunderbee]

My 16 year old son has had second episode in right eye of a whole chunk of the visual field going dark, basically a kind of partial blindness. Last time it happened it was 6 months ago, he refused to go to A&E and it disappeared over about half an hour.
This afternoon it happened quite suddenly after he got out of the shower, and was accompanied by a left side headache which came on after and is hanging around, worse when bending down or exerting himself; and also at the time of the visual disturbance, pins and needles/numbness down into his right hand and in his face under his eye. He was very slightly struggling to find the right words for things for a few minutes too.
We've just spent 3 hours at A&E where the consultant tells us it's likely to be a migraine. Am I being ridiculous to think this just doesn't seem quite right as a conclusion? No history of migraines or seizures or anything else relevant.
Should we just wait till the next episode? Son is very freaked out, as am I. He is usually well, very fit and sporty gym type.
Any advice really gratefully received.

Sounds like a migraine with visual aura. It normally lasts up to 30 mins and is scary for the person who gets them! Some people get the headache and some don't so only get the visual effects. It can be triggered by a lot of things so maybe keep a diary of food/drink prior to getting them!

I get a feeling of sight loss, but the vision doesn't actually go. My right eye thinks it can't see properly, but if I cover my left eye I can still see so my right eye must be wrong! It's almost like a refusal to look through that eye. Very weird.

Op did they do your sons blood pressure?
Just checking I've got this right, your son presented to A &E with

1. visual disturbance or partial loss of sight?
2. difficulty finding the words he wanted
3. pins and needles/ numbness in his Right hand and underneath his ?right eye.
4. left sided headache which was worse bending down or on exertion.

The A & E dr. Did not examine his eyes. Did not refer you to ophthalmology, Told you no point is CT as radiation risk and not a stroke as no ongoing deficits? Not if it's a bloody TIA (mini stroke, they resolve quickly, it's very unlikely but not impossible).
Please do the following (and shout loudly if you have to) 1)request nurse does blood pressure check ASAP
2) demand don't ask (albeit politely) that your son is referred to ophthalmology .
If it happens again treat it as an emergency and ambulance.
TIAs and strokes are really, really rare in young people, but sadly they do occur. Hopefully the dr is right and this is a migraine, but blood pressure and ophthalmology referral are needed.
Obviously if they did take his blood pressure in A &E, ignore everything I've written (apart from ophthalmology referral ) If they didn't please get this done.

The above poster is right. I am a doctor. The most likely diagnosis is migraine however the serious things do need ruling out such as Transient ischaemic attack. Although rare they can happen in young people.
I think he does need to see a stroke physician in a TIA clinic . An MRI is more sensitive and avoids radiation.
He needs an eye appointment too..

I would go back to ED

I get these too. Exactly the same symptoms you've described. I know this is an American site but I found the explanations really useful. https://americanmigrainefoundation.org/resource-library/hemiplegic-migraine/ Mine also started about your ds's age and were only diagnosed after several trips to a and e and follow ups such as mri and eye test etc to rule anything more serious else out. I really sympathise as it was such a scary thing when it started happening both for me and my dm. I know she was really worried and upset seeing me like that. I know a few people who have the same and all have become less frequent with age and also better managed. There's numerous treatment options available so the gp is definitely worth a visit and if they aren't helpful request a referral to a specialist. Wishing you both well

@thunderbee is he a fussy eater? There have been several cases of partial and total blindness in Australia in teenagers who had a beige junk food diet made of chicken nuggets , chips, white bread .... and it was due to a severe vitamin A deficiency . I believe similar cases occurred in UK, USA, ...
A vitamin B12 deficiency can cause neurological issues as well, with headaches and temporary blindness.

I get hemiplegic migraines which are very stroke-like numbness down one side of my body including my face and tongue, slurred speech and jumbled speech, then cyclical vomiting. Migraines can mimic lots of things which can be utterly terrifying when you don’t know what it is. Hope he’s feeling better soon.

Many thanks all, I've got an emergency eye clinic appointment booked for this afternoon, and I will try to get hold of the GP as well. @offyougotwantychops I was wondering about TIAs too, as parents and in laws all had these in their last years. You're all correct on your understanding of what happened. He did have his blood pressure and oxygen saturation checked, 67/107 and 97% and no concerns raised there so I am guessing ok? No idea what a 16 year olds blood pressure is supposed to be.
@comoran he's not an especially fussy eater and takes a multivitamin tablet fairly regularly; very into working out so also tends to eat a reasonably balanced diet (for a teenager).

For those of you who have had similar symptoms diagnosed as migraines, is the episode of sight loss relatively short? Friends who are migraine sufferers who I know have several days sometimes of excruciating symptoms, and the transient nature of some of this made me wonder .

Thank you all so much for so many detailed replies, it's been so helpful.

Good to hear you've managed to get an appointment for this afternoon OP.

I can only speak for myself as everyone will be different.

Disturbance to my sight is normally the first sign I've got a migraine. Other times it's the pins and needles and slightly numb feeling. It normally starts like when you have looked at something bright and then get little grey dots or hazes where I see zig zags.

The sight disturbance is normally short lived. The same for the pins and needles. Anything from about ten minutes to half an hour for both. This is then followed by the other symptoms normally the head pain.

Strangely which ever side the pins and needles are the head pain will be the opposite side. If they weren't so scary I'd find the way the body works so interesting. I do have a lovely GP who fully understands and so has reassured me as I too had fear of stroke etc. Once he explained what my body was doing I found it far less scary and I manage really well with them now and just see them as an inconvenience.

Good luck at the appointment today.

Like others say it is probably a migraine. But personally I would push for an MRI to make there's nothing more sinister going on.

Sorry OP I should have added mine are relatively short lived and normally only last a couple of hours with the severe symptoms at most. After those symptoms have passed I'm just left feeling quite drained and with a manageable headache, however my aunt also suffers migraines (different symptoms) and can have one for several days where she needs to be in a quiet dark room. Migraines come in all shapes and sizes but often people think of migraines as being the type my aunt has I think because it is more common to have those types. Hemiplegic migraine is quite rare.

This could be ocular neuritis. It is one of the first signs of MS. Steroids are needed. Please ask for an eye specialist / neurologist to get this ruled out. I'm sure it's not but the eye thing coupled with the arm sensations could point to this.

Hello @thunderbee hope all is well. Any news what happened at the eye clinic today ? X

Hi all, apologies for the delayed update; eye clinic had no space for us so passed us on to emergency appointment at commercial opticians. Very thorough test of visual field, back of eye etc - they couldn't find anything wrong, no evidence of anything putting pressure on the optic nerve or or any problems with retina, so referral back to GP due to atypical symptoms. Their diagnosis too is ?migraine but asking GP to take a look as a 'priority' rather than an 'emergency' so I guess nothing too much to worry about right now.
GP receptionist took the letter to scan onto the system, and if the GPs have concerns they will ring on Monday hopefully.

If you're expecting that the GP will know whether it's anything sinister just from the tests so far, you're mistaken.
In your shoes I would be insisting on an MRI. Better safe than sorry.

Headsmart

Hi, it sounds like migraines. Doesn't mean it couldn't be something else, but it is v common with migraines.

I have similar - first one was terrifying. I now manage them very well with hydration, food and rest. You learn your triggers.

I get visual symptoms with my migraine and some of the other symptoms listed.

Usually visually symptoms last < 30mins.

I get ocular migraine. Visual loss/disturbance but no pain in my head at all. I do feel a bit unwell after them though, kinda groggy headed & really tired. I was on beta blockers for a while, they helped. And more recently sertraline.. I wasn’t overly keen on that though, made me feel a bit spaced out so I stopped!

Have a look at Antiphospholipid Syndrome aps-support.org.uk/about-aps/what-are-the-symptoms Not saying it is this, but this is under diagnosed. If it is this he might be prescribed something simple like daily aspirin to help with symptoms and to protect against strokes etc.

a relative (mid 30s) had a stroke for which the first symptom was sudden vision loss in one eye.
I'm sure a&e check for that. in relative's case an ultrasound was taken of the big blood vessels in the neck.
relative was put on blood thinners for the rest of their life to try prevent further strokes.

I'm glad you ended up at an optician, they are the eye experts. Did they give you advice on what to do if it happens again? I would say of ot does get an emergency appointment with the optician in case it is anything that doesn't show up after a while. In Scotland the opticians will get a payment from the NHS for dealing with this but I don't know about elsewhere.