Aura

Aura: Excerpt from In a Page: Signs and Symptoms

A subjective sensory phenomenon that may involve any of the five senses, such as visual auras (often described as flashing lights), sensory auras (paresthesias), or auditory auras. Other auras may be described as dreamlike or déjà vu sensations, or odd odors. The type of symptom may be related to the brain area involved (e.g., visual aura suggests occipital lobe pathology).

Differential Diagnosis

• Epilepsy
  –Recurrent seizures
  –Strong family history
• Migraine with aura
  –Usually visual aura (e.g., scotoma, flashing lights) lasting less than 60 minutes
  –Usually fully reversible with rare migrainous infarction (like CVA)
  –Migraine headache follows aura within 60 minutes and lasts 4–72 hours; however, aura may occur without headache
  • Partial seizure
    –60% of patients with focal seizures have an accompanying aura
    –Aura symptoms are associated with the brain area where they originate (e.g., occipital lobe seizure results in seeing lights)
    –Simple partial seizures result in focal tonic-clonic motor activity without loss of consciousness
    –Complex partial seizures progress to decreased consciousness and unresponsiveness
  • Tonic-clonic (grand mal seizure) seizures result in an abrupt loss of consciousness followed by stiffness (tonic); the patient then starts jerking (clonic) for an additional 2–3 minutes; rare aura
  • Pituitary adenoma or other underlying pathology that predisposes to migraines, seizures, or altered sensations (taste, smell)
  • Hallucinations (not actually an aura)
  • Physiologic nonepileptic seizures
    –Usually due to an underlying physiologic cause (e.g., fever, hypoglycemia, hypo- or hyperthyroidism, renal failure, cerebral anoxia)
  • Absence seizures (petit mal seizure) only rarely have an aura

  Workup and Diagnosis

  • History is very important
    –Type of aura (any of five senses)
    –Loss of consciousness
    –Associated activities and triggers (e.g., stress, medications, exertion, trauma, foods)
    –Postaura symptoms (e.g., headache, loss of consciousness, seizure)
    –History or family history of seizures or migraines
    –Review past medical history for head injury, stroke, dementia, intracranial infection, and alcohol or drug abuse
    –Full head, neck, and neurologic exam (look for one-sided features that suggest pathology on opposite side of brain)
    –Examine for trauma following loss of consciousness
  • Initial tests may include glucose, electrolytes, calcium, magnesium, CBC, BUN/creatinine, and toxicology screen
  • EEG may be indicated if seizure activity is suspected
    (provocative EEG with triggers gives higher yield)
    –Normal EEG does not rule out epilepsy
    –May be abnormal in migraines
  • MRI to rule out cerebral pathology
  • CT if physiologic seizure or trauma is involved (not indicated in patients with migraine and normal neurologic exam unless pattern of migraine has changed)

  Treatment

  • Migraine
    –Avoid triggers (e.g., alcohol, stress, fatigue)
    –NSAIDs and/or acetaminophen
    –5-HT₁ agonists (e.g., sumatriptan) are useful during the
    headache phase and ergotamines (e.g., dihydroergotamine) are effective for status migraines; however, neither are effective to relieve aura
  • Epilepsy
    –Status epilepticus: Stabilize patient and administer IV benzodiazepines and fosphenytoin
    –Antiepileptics if risk for recurrent seizures: Phenytoin, carbamazepine, or valproate for generalized or partial seizures; ethosuximide or valproate for absence seizures; lamotrigine or valproate for mixed seizures

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Classic migraine

• Back to disease: Classic migraine: Introduction
• Next Book Extract About Classic migraine: Headache (In a Page: Signs and Symptoms)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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