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Transient visual disturbances as a primary manifestation of metastatic brain tumours

A 41-year-old male presented with a chief complaint of episodic flashes of light and subsequent partial right-sided blur/vision loss lasting approximately one hour and then returning to normal. It was indeterminate if symptoms involved one or both eyes as he did not cover either eye; however, he reported a mild associated headache and a prior episode that week which also resolved. Emergency room evaluation that morning revealed no significant findings, and the patient was subsequently seen in the eye clinic for further examination. He denied any ocular conditions, medical problems, or associated stroke-like symptoms. Visual acuity was 6/6 in each eye with normal extraocular muscle movements, pupils, confrontation visual fields, and colour vision. Anterior and posterior segment examination including dilation was unremarkable without pertinent findings or retinal emboli. The diagnosis of migraine with visual aura was made based on the clinical symptoms, exam findings, and absence of other risk factors including microvascular disease. However, due to his older age and absence of a history of migraines a closer followup was recommended. He was advised to return to the eye clinic for additional testing, and seek emergency care if symptoms persisted or experienced signs of stroke.