Aphasic and visual aura with increased vasogenic leakage: An atypical migrainosus status

Lanfranconi, Silvia; Corti, Stefania; Bersano, Anna; Costa, A.; Prelle, A.; Sciacco, Monica; Bresolin, Nereo; Ghione, Isabella

doi:10.1016/j.jns.2009.06.009

Cited by 9 publications

(1 citation statement)

References 15 publications

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“…Previous single‐photon emission computed tomography (CT), PET, CT, and magnetic resonance imaging (MRI) studies have shown dramatic changes in blood flow, metabolism, and contrast enhancement during migraine aura, including prolonged aura and the aura of hemiplegic migraine . Several recent studies added to the constantly expanding number of these case reports . To briefly summarize, these studies show that a variety of physiological responses can be observed during migraine aura, including hypoperfusion, hyperperfusion, hypometabolism, vasogenic edema, and breakdown of the blood–brain barrier.…”

Section: The Aura Phasementioning

confidence: 99%

The Evolution of a Migraine Attack – A Review of Recent Evidence

Charles

2012

Headache

150

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A migraine attack is an extraordinarily complex brain event that takes place over hours to days. This review focuses on recent human studies that shed light on the evolution of a migraine attack. It begins with a constellation of premonitory symptoms that are associated with activation of the hypothalamus and may involve the neurotransmitter dopamine. Even in the premonitory phase, patients experience sensitivity to sensory stimuli, indicating that central sensitization is a primary phenomenon. The migraine attack progresses to a phase that in some patients includes aura, which involves changes in cortical function, blood flow, and neurovascular coupling. The aura phase overlaps with the headache phase, which is associated with further changes in blood flow and function of the brainstem, thalamus, hypothalamus, and cortex. Serotonin receptors, nitric oxide, calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide, and prostanoids are demonstrated specific chemical mediators of migraine based on therapeutic and triggered migraine studies. A number of migraine symptoms persist beyond resolution of headache into a postdromal phase, accompanied by persistent blood flow changes in several brain regions. Although these phases of migraine have substantial temporal, neurochemical, and anatomical overlap, each represents an important window onto the pathophysiology of migraine as well as a target for therapeutic intervention. A comprehensive approach to migraine requires an understanding of the entire range of mechanisms and resultant symptoms that occur throughout the evolution of an attack. Key words: headache, positron emission tomography, magnetic resonance imaging, premonitory, aura, postdromeThe understanding of migraine pathophysiology continues to advance rapidly, bringing fresh opportunities for the development of novel acute and preventive therapies. It is convenient to describe the phases of a migraine attack (premonitory, aura, headache, postdrome) relative to the headache phase because headache is the most easily recognizable, stereotyped, and quantifiable feature of an attack. But for a significant number of patients, the other phases of a migraine attack can be more prolonged and even more disabling than headache. Growing evidence indicates that the phases of migraine do not occur in a discrete and linear fashion but rather reflect overlapping chemical, physiological, and anatomical mechanisms.

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Section: The Aura Phasementioning

confidence: 99%