1. |
Flashes of bright light in the visual field? |
2. |
Blurred spot in the visual field? |
3. |
Scotoma (a partial loss of vision)? |
4. |
Twinkling zig-zag lines in the visual field? |
5. |
Tunnel vision (narrowing of the visual field)? |
6. |
Deformed or deformed images, unrelated to the disturbance of vision? |
7. |
Difficulties in recognizing faces, unrelated to the disturbance of vision? |
8. |
Objects becomes biger or smaller? |
9. |
Tingling or numbness in hand, leg, and face (head)? |
10. |
Difficulties in recognizing objects by touch? |
11. |
Difficulties in activities requiring coordination and movement of extremities? |
12. |
Unawareness of one part of your body? |
13. |
Difficulties in recalling names? |
14. |
Difficulties in recalling or remembering events from the past? |
15. |
Difficulties in speaking even when you knew what you wanted to say? |
16. |
Difficulties in understanding people who were talking to you? |
17. |
Difficulties in reading comprehension, unrelated to visual disorders? |
18. |
Difficulties in writing that were not caused by the disturbance of vision? |
19. |
Difficulties in calculating and/or memorizing numbers? |
If you expirienced symptoms of visual aura please report the level of involvement of the visual field (a quarter, half or the whole of the visual field): |
How did your visual aura symptoms last for? |
If you expirienced symptoms of somatosensory aura please report the number of body regions that were involved (upper limb, head and/or trunk/lower limb): |
How did your somatosensory aura symptoms last for? |
If you expirienced symptoms of dysphasic aura please report the duration: |
How long was the duration of a headache? |
Please rate head pain intensity on the scale from 1 to 10: |