Aura

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 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 and may impair his memory of the event.

The aura associated with a classic migraine headache results from cranial blood vessel vasoconstriction. Diagnostically important, it helps distinguish a classic migraine from other types of headaches.

Typically, an 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 migraine by taking appropriate drugs.

Action stat!

When an aura rapidly progresses to the ictal phase of a seizure, quickly evaluate the seizure and be alert for life-threatening complications such as apnea. When an aura heralds a classic migraine, make the patient as comfortable as possible. Place him in a dark, quiet room and administer drugs to prevent the headache if necessary.

History and physical examination

Obtain a thorough history of the patient's headache or seizure history, 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.

Then perform a complete neurologic examination.

Medical causes

Classic migraine headache.A 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. It slowly intensifies; when it peaks, it may cause photophobia, nausea, and vomiting.

Seizure, generalized tonic-clonic.A generalized tonic-clonic seizure may begin with or without an aura. The patient loses consciousness and falls to the ground. His body stiffens (tonic phase), and then he experiences rapid, synchronous muscle jerking and hyperventilation (clonic phase). The seizure usually lasts 2 to 5 minutes.

Nursing considerations

▪ Advise the patient to keep a diary of factors that precipitate each headache or seizure as well as associated symptoms to help you evaluate the effectiveness of drug therapy and recommend lifestyle changes.

Patient teaching

▪ Teach the patient stress-reduction measures.

▪ If the patient recognizes the aura as a warning sign, tell him to prevent the headache by taking appropriate medications.

▪ Explain diagnostic tests or procedures.

▪ Explain the underlying disorder and treatment plan.

▪ If the patient has a seizure disorder, emphasize the importance of taking anticonvulsants as directed.

▪ Stress the importance of regular follow-up appointments for blood studies.

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Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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