A 13-year-old Hispanic male presented to the optometrist for yearly evaluation. He displayed a moderate myopic prescription which was correctable to 20/20 in each eye with only a minor increase in his myopic Rx. The patient was new to the office and, as part of their standard exam, an FDT screening visual field was performed which revealed a superior temporal quadranopsia. Upon further questioning, the patient reported headaches which had increased in intensity over the last few years. He was referred to me for evaluation of these headaches and the visual field defect.

A full threshold Humphrey visual field was performed at our office which confirmed the superior right quadranopsia. He also received a full dilated retinal and optic nerve exam which was negative for optic nerve pallor or edema; essentially all ocular findings were WNL. The headache symptoms were consistent with a classic migraine with known triggers, visual aura, and resolution with darkness, OTC meds, and sleep. His mother reported the patient’s headaches for at least the last five years but felt he complained of headaches more frequently over the last year or two.

I ordered an MRI of the brain with and without contrast which revealed a posterior, left arteriovenous malformation (AVM) with extension into the left occipital lobe. The patient was referred to the neurosurgery department at Texas Children’s Hospital in Houston.  Treatment will likely consist of a combination of surgical resection, embolization, and/or radiosurgery. The patient’s headaches may be associated with the AVM or may be unrelated pediatric migraines. The patient will return to us for follow up ophthalmological exams and visual fields.