Aura

Aura: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)

An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing types of auras.)

When associated with a seizure, an aura stems from an irritable focus in the brain that spreads throughout the cortex. Although an aura was once considered a sign of an impending seizure, it’s now considered the first stage of a seizure. Typically, it occurs seconds to minutes before the ictal phase. Its intensity, duration, and type depend on the origin of the irritable focus. For example, an aura of bitter taste commonly accompanies a frontal lobe lesion. Unfortunately, an aura is difficult to describe because the postictal phase of a seizure temporarily alters the patient’s level of consciousness, impairing his memory of the event.

The aura associated with a classic migraine headache results from cranial vasoconstriction and typically involves visual disturbances. Diagnostically important, it helps distinguish a classic migraine from other types of headaches. Typically, the aura develops over 10 to 30 minutes and varies in intensity and duration. If the patient recognizes the aura as a warning sign, he may be able to prevent the headache by taking appropriate drugs.

Emergency interventions

History and physical examination

After providing emergency care, obtain a thorough history of the patient’s headaches or seizures, asking him to describe any sensory or motor phenomena that precede each headache or seizure. Find out how long each headache or seizure typically lasts. Does anything make it worse, such as bright lights, noise, or caffeine? Does anything make it better? Ask the patient about drugs he takes for pain relief.

Medical causes

Migraine headache, classic

A classic migraine is preceded by a vague premonition and then, usually, a visual aura involving flashes of light. The aura lasts 10 to 30 minutes and may intensify until it completely obscures the patient’s vision. A classic migraine may cause numbness or tingling of the lips, face, or hands; slight confusion; and dizziness before the characteristic unilateral, throbbing headache appears. The headache slowly intensifies; when it peaks, the patient may experience photophobia, nausea, and vomiting.

Seizure, generalized tonic-clonic

A generalized tonic-clonic seizure may begin with an aura. The patient loses consciousness and falls to the ground. His body stiffens (tonic phase); then he experiences rapid, synchronous muscle jerking and hyperventilation (clonic phase). The seizure usually lasts 2 to 5 minutes.

Special considerations

Advise the patient to keep a diary of factors that precipitate each headache as well as associated symptoms to help you evaluate the effectiveness of drug therapy and recommend lifestyle changes. Stress-reduction measures usually play a role here.

Pediatric pointers

Watch for nonverbal clues that may be associated with an aura, such as rubbing the eyes, coughing, and spitting. When taking the seizure history, recognize that children—like adults—tend to forget the aura. Ask simple, direct questions, such as “Do you see anything funny before the seizure?” and “Do you get a bad taste in your mouth?” Give the child ample time to respond because he may have difficulty describing the aura.

Pictures

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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