1) Migraine with AURA::
Recurrent attacks of unilateral fully reversible visual, sensory, or other CNS symptoms that develops gradually over minutes and usually followed by Headache and associated Migraine Symptoms.
2) Total 20-40% prevalent,Increased risk in 1st degree Relative + twins + Heritibility. Onset::
Gradual and progressive, unlike abrupt in Stroke.
AURA consists of Positive symptoms like flashing lights, and paresthesia while stroke dominates Negative symptoms like weakness.
3) Duration::
Typically 30 minutes but may be Prolong upto 4 hours. Symptoms::
Visual(90%,most common) > Sensory, language, motor.
Visual::
Scintillating scotoma, Flashing lights, Blurry Visions.
4) Sensory::
Paresthesia of face & hand, may spread to lower limbs & trunk.
Language::
Word finding difficulty, Dysphasia.
Brainstem Aura::
Dizziness, vertigo, dysarthria, diplopia, tinnitus, hyperaccusis, ataxia, decreased Level of Consciousness.
5) AURA can occur without headaches, headaches with aura have Increased Pain severity, and less duration. Headaches without aura have less severe headaches and increased duration of headaches.
6) MECHANISM BEHIND AURA::
VASCULAR CHANGES::
Brain Hypoperfusion in distribution correlated with aura symptoms.
7) CORTICAL SPREADING DEPRESSION::
Slowly propagated depolarization followed by suppression of electro graphic activity, associated with massive release of neurotransmitters and either vasodilation or vasoconstriction. Also observed in TBI, Ischemic and Hemorrhagic strokes.
8) AURA Associations and Significance::
Sex Hormones... Especially Estrogen Based.
PFO... with aura and Stroke.
Stroke... Migraine with aura & stroke
Psychiatric..Depression, Panic, Bipolar, suicidality
9) Misconceptions::
1:Avoiding Triptans in migraine with AURA due to possible vasoconstrictive effects of drug, But MRA shows that Drug don't constrict Vessels.
10) 2:Avoiding Estrogen based Contraceptive pills, that it will increase migraine with aura, secondary increasing stroke risk with migraine with aura, All studies agree to that absolute risk is small and low dose estrogen can be used.
11) #Neurology #neurologyresident #neurologist #MedTwitter #NeuroTwitter #vascularNeurology #headache #migraine #stroke #triptans
Share this Scrolly Tale with your friends.
A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.