HeadWise HeadWise: Volume 6, Issue 2 - Page 24

Prior to these events , 65 % of patients had a history of headaches and only 40 % of these events were accompanied by headaches . This report expanded further the idea that these transient neurologic symptoms are reflective of migraine physiology as most patients had repetitive , similar episodes , all beginning late in life .
TMAs are transient , by definition , but can progress during the event , meaning that after they begin , the attack may change in character over the course of the episode . For example , paresthesias may march from one part of the body to the next over a few minutes . The symptoms have a “ build-up ” and evolve . A person may begin experiencing flashing lights , then a field cut , and then develop a speech disturbance with or without resolution of the field cut . The length of time of the TMA varies , but on average , most people report a duration from 5 minutes to a few hours . Some patients even experience symptoms for over 24 hours , although this is rare .
“ Late-life migraine accompaniments ” are not rare ; however , they are a diagnosis of exclusion , and other reasons for these symptoms must be explored prior to establishing the diagnosis of TMA . Other causes to consider include transient ischemic attacks ( TIAs ), seizures , subarachnoid hemorrhages ( brain hemorrhages ), vascular malformations , and brain tumors . These symptoms merit an immediate visit to a doctor or the emergency department for evaluation . “ Late-life migraine accompaniments ” are a benign condition , but other causes of these symptoms are not , and must first be excluded . Certain tests such as basic blood laboratory studies , magnetic resonance imaging ( MRI ), electroencephalography ( EEG ), and special imaging of the blood vessels in the brain and neck ( magnetic resonance or CT angiography , or carotid ultrasound ) will likely be performed to help investigate the causes of the symptoms .
There are a few hints to clinically distinguish between migraine auras and TIAs . Migraine auras tend to have a gradual build-up and evolve over time , and they may move from one body part to the other , or progress from visual to sensory to speech disturbances over a period of time . The visual aura phenomenon are often “ positive ” – involving both visual fields or moving from one side to the other and progressing over the course of minutes to an hour . By positive , it means they may flash or shimmer ( Figure 1 ).
Figure 1
They can enlarge or change size . After being positive , they can become negative with blind spots . Visual symptoms in TIAs tend to be “ negative ” from the start of the episode , meaning patients often describe complete loss of vision , mainly on one side or in one eye . This develops over seconds , may last for a few minutes , then resolve within seconds . TIAs tend not to cause the positive symptoms . TIA symptoms are abrupt , whereas migraine auras tend to be gradual in onset .
When distinguishing between sensory phenomena in aura and sensory phenomena in TIA , the distribution , time course , and repetitiveness are important . Aura tends to involve a sensation of tingling or “ pins and needles ” that may start in one part of the body and then move up that body part and sequence to another . The hands and face are most commonly affected ( this is called a “ cheirooral ” distribution ) ( Figure 2 ).
Figure 2
24 HeadWise ® | Volume 6 , Issue 2 • 2016
Prior to these events, 65% of patients had a history of headaches and only 40% of these events were accompanied by headaches. This report expanded further the idea that these transient neurologic symptoms are reflective of migraine physiology as most patients had repetitive, similar episodes, all beginning late in life. TMAs are transient, by definition, but can progress during the event, meaning that after they begin, the attack may change in character over the course of the episode. For example, paresthesias may march from one part of the body to the next over a few minutes. The symptoms have a “build-up” and evolve. A person may begin experiencing flashing lights, then a field cut, and then develop a speech disturbance with or without resolution of the field cut. The length of time of the TMA varies, but on average, most people report a duration from 5 minutes to a few hours. Some patients even ex ɥѽ́ȁٕ(Ё̰ѡ՝ѡ́́Ʌɔ+q1єɅϊtɔЁɅɔ)ݕٕȰѡ䁅ɔͥ́፱ͥѡ)ɕͽ́ȁѡ͔ѽ́Ёɕɥ)Ѽх͡ѡͥ́Q5=ѡȁ͕)ѼͥȁՑɅͥЁ͍х̀Q%̤)͕ɕ̰ՉɅɡ̀Ʌɡ̤)م͍ձȁɵѥ̰Ʌյ̸Q͔)ѽ́ɥЁє٥ͥЁѼѽȁ)ѡɝ䁑ѵЁȁمՅѥq1є)Ʌϊtɔѥ)Ёѡȁ͕́ѡ͔ѽ́ɔа)Ё፱Ց хѕ́Ս́ͥ)ɅѽՑ̰ѥɕͽ5I$)ɽɅ䀡ѡ)ٕ͕́ѡɅѥɕͽ)ȁ PɅ䰁ȁɽѥձɅͽչݥ䁉)əɵѼٕѥєѡ͕́ѡѽ̸)Qɔɔ܁́Ѽ䁑ѥե͠ݕ)ɅɅ́Q%̸5ɅɅ́ѕѼٔ)ɅՅեٽٕٔȁѥѡ䁵)ٔɽЁѼѡѡȰȁɽɕ́ɽ)٥ՅѼ͕ͽѼɉٕ́ȁɥ)ѥQ٥ՅɄɔѕqͥѥٗtL)ٽ٥Ѡ٥Յ́ȁ٥ɽͥѼ)ѡѡȁɽɕٕͥȁѡ͔ѕ́Ѽ)ȸ ͥѥٔЁ́ѡ䁵䁙͠ȁ͡(ɔĤ)ɔ)Q䁍ɝȁͥ锸ѕȁͥѥٔ)ѡ䁍ѥٔݥѠ̸YՅ)ѽ́Q%́ѕѼqѥٗtɽѡх)ѡͽѥ́ѕ͍ɥє)́٥ͥ䁽ͥȁ唸Q)ٕٕ́ȁ͕̰䁱Ёȁ܁ѕ̰ѡ)ɕͽٔݥѡ̸͕Q%́ѕЁѼ͔ѡͥѥٔ)ѽ̸Q%ѽ́ɔаݡɕ́Ʌ)Ʌ́ѕѼɅՅ͕и)]ѥե͡ݕ͕ͽ)Ʉ͕ͽQ%ѡɥѥ)ѥ͔ɕѥѥٕ́ɔхиɄѕ)Ѽٽ͕ٔͅѥѥȃq́ϊt)ѡЁхЁЁѡ䁅ѡٔ)ѡЁЁ͕ՕѼѡȸQ́)ɔЁ䁅ѕѡ́́qɼ)ɅtɥѥɔȤ)ɔ()!\͔ ))Yյذ%Քȃ