Iatrogenic visual aura: a case report and a brief review of the literature

Buture, Alina; Khalil, Modar; Ahmed, Fayyaz

doi:10.2147/tcrm.s134178

Cited by 5 publications

(15 citation statements)

References 25 publications

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“…This hypothesis is consistent with an enhanced likelihood of clot formation in migraineurs, who reportedly show an increased incidence of hypercoagulability [43] and atrial fibrillation [36]. As a potential path for cerebral microembolism, an increased incidence of persistent foramen ovale has been reported in migraineurs [105], and paradoxical air microembolism as well as cardiac catheterization with presumably associated microembolic events have been shown to induce headache in migraineurs [106–108]. Along the same line, the increased stroke risk in migraineurs is highest for stroke of cardioembolic etiology, and in the peri-operative emboli-prone setting [109, 110].…”

Section: Mechanisms Underlying the Migraine Sd And Stroke Associationsupporting

confidence: 57%

Aura and Stroke: relationship and what we have learnt from preclinical models

Yemişçi

Eikermann-Haerter

2019

J Headache Pain

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BackgroundPopulation-based studies have highlighted a close relationship between migraine and stroke. Migraine, especially with aura, is a risk factor for both ischemic and hemorrhagic stroke. Interestingly, stroke risk is highest for migraineurs who are young and otherwise healthy.Main bodyPreclinical models have provided us with possible mechanisms to explain the increased vulnerability of migraineurs’ brains towards ischemia and suggest a key role for enhanced cerebral excitability and increased incidence of microembolic events. Spreading depolarization (SD), a slowly propagating wave of neuronal depolarization, is the electrophysiologic event underlying migraine aura and a known headache trigger. Increased SD susceptibility has been demonstrated in migraine animal models, including transgenic mice carrying human mutations for the migraine-associated syndrome CADASIL and familial hemiplegic migraine (type 1 and 2). Upon experimentally induced SD, these mice develop aura-like neurological symptoms, akin to patients with the respective mutations. Migraine mutant mice also exhibit an increased frequency of ischemia-triggered SDs upon experimental stroke, associated with accelerated infarct growth and worse outcomes. The severe stroke phenotype can be explained by SD-related downstream events that exacerbate the metabolic mismatch, including pericyte contraction and neuroglial inflammation. Pharmacological suppression of the genetically enhanced SD susceptibility normalizes the stroke phenotype in familial hemiplegic migraine mutant mice. Recent epidemiologic and imaging studies suggest that these preclinical findings can be extrapolated to migraine patients. Migraine patients are at risk for particularly cardioembolic stroke. At the same time, studies suggest an increased incidence of coagulopathy, atrial fibrillation and patent foramen ovale among migraineurs, providing a possible path for microembolic induction of SD and, in rare instances, stroke in hyperexcitable brains. Indeed, recent imaging studies document an accelerated infarct progression with only little potentially salvageable brain tissue in acute stroke patients with a migraine history, suggesting an increased vulnerability towards cerebral ischemia.ConclusionPreclinical models suggest a key role for enhanced SD susceptibility and microembolization to explain both the occurrence of migraine attacks and the increased stroke risk in migraineurs. Therapeutic targeting of SD and microembolic events, or potential causes thereof, will be promising for treatment of aura and may also prevent ischemic infarction in vulnerable brains.

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Section: Mechanisms Underlying the Migraine Sd And Stroke Associationsupporting

confidence: 57%

Aura and Stroke: relationship and what we have learnt from preclinical models

Yemişçi

Eikermann-Haerter

2019

J Headache Pain

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“…Mild headache or migraine aura without headache may be features of migraine after ablation (9, 14), as in our case. In most cases, these attacks occurred within one week after the procedure and spontaneously disappeared within three months (9-16), which is in accordance with our case. However, a few patients complained of persistent migraine (10, 13).…”

Section: Discussionsupporting

confidence: 92%

“…Although headache after catheter ablation is generally described as a primary headache in previous reports (9-16), it is actually considered to be a secondary one. The most appropriate diagnosis in accordance with ICHD-3 may be headache attributed to other disorders of homeostasis (code 10.7) (7).…”

Section: Discussionmentioning

confidence: 99%

“…Jordaens et al reported its occurrence as 8% (12), but this extraordinarily high rate may have been because of an inappropriate migraine questionnaire. The clinical characteristics of de novo migraine-like headache or the exacerbation of prior migraine are shown in Table (9-16). With respect to the migraine subtype after the procedure, migraine with aura or isolated visual aura were more common than migraine without aura.…”

Section: Discussionmentioning

confidence: 99%

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Migraine-like Headache after Transseptal Puncture for Catheter Ablation: A Case Report and Review of the Literature

et al. 2019

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Catheter ablation for atrial fibrillation creates an iatrogenic atrial septal defect by transseptal puncture, which may produce a transient right-to-left shunt. We encountered a 44-year-old man who presented with de novo migraine-like headache after cryoballoon ablation for atrial fibrillation. On reviewing the literature, we found additional cases in which migraine-like headache occurred within one week after the procedure and spontaneously within three months. We should recognize migraine-like headache as a potential complication of catheter ablation.

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“…Of the 53 "nonstructural" cases, 13 fulfilled ICHD criteria for MWA (Figure 2). 65,66,68,72,77,82,83,86,87,92,98 In these cases, aura was assumed to be caused by cardiac myxoma (n = 1), viral meningitis (n = 1), head trauma (n = 1, severity not reported), idiopathic intracranial hypertension (n = 1), neurosyphilis (n = 1), cerebral venous thrombosis (n = 1), stellate ganglion block (n = 1), cardiac ablation (n = 4), and the presence of prosthetic heart valves (n = 2). Aura was associated with headache in all cases and preceded the headache in nine.…”

Section: Cases-nonstructuralmentioning

confidence: 99%

Symptomatic migraine: A systematic review to establish a clinically important diagnostic entity

et al. 2021

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Objective To determine if a clinical presentation indistinguishable from migraine can occur due to an underlying condition or pathology, that is, "symptomatic migraine." Background It is currently not clear whether migraine truly can be caused by an underlying condition or pathology. Characterization of the etiology and clinical features of possible symptomatic migraine is of significant clinical importance and further may help elucidate the pathophysiology of migraine. Methods We devised operational diagnostic criteria for “symptomatic migraine” and “possible symptomatic migraine” requiring strong evidence for a causal relation between underlying cause and migraine symptoms adhering strictly to diagnostic criteria. PubMed was searched for case reports of symptomatic migraine from inception to March 2020. Only articles published in English or German were included. No restrictions were placed on study design. Relevant references in the articles were also included. Papers were systematically reviewed by two independent reviewers for detailed clinical features of migraine as well as the proposed underlying conditions and the effects of treatment of these conditions. Results Our search retrieved 1726 items. After screening, 109 papers comprising 504 cases were reviewed in detail. Eleven patients with migraine with aura (MWA) fulfilled our working criteria for symptomatic migraine, and 39 patients fulfilled our criteria for possible symptomatic migraine. The most common etiologies of symptomatic migraine were arteriovenous malformations, carotid stenosis, dissection or aneurysm, brain infarctions, meningioma, and various intra‐axial tumors. Conclusions Symptomatic MWA, indistinguishable from idiopathic MWA, may occur due to cortical lesions or microembolization. We found no clear evidence supporting the existence of symptomatic migraine without aura although we did identify possible cases. Our findings are limited by the available literature, and we suggest that prospective studies are needed.

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Iatrogenic visual aura: a case report and a brief review of the literature

Cited by 5 publications

References 25 publications

Aura and Stroke: relationship and what we have learnt from preclinical models

Aura and Stroke: relationship and what we have learnt from preclinical models

Migraine-like Headache after Transseptal Puncture for Catheter Ablation: A Case Report and Review of the Literature

Symptomatic migraine: A systematic review to establish a clinically important diagnostic entity

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