Migraine with Aura as a Stroke Mimic

Park, Jeong Jin; Kim, Soo Jeong; Kim, Hahn Young; Roh, Hong Gee; Kim, Dong Wook

doi:10.1017/cjn.2019.316

Cited by 11 publications

(13 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only half of the patients ful lled IHS criteria previous to admission. Like in previous studies [5,20], we found a higher prevalence of sensory symptoms, mainly negative like numbness, making it hard to distinguish from a thalamic stroke. Although visual aura is the most frequent in MA [4], it is not the most common in cases that raise stroke suspicion.…”

Section: Discussionsupporting

confidence: 74%

Migraine Aura mimicking Stroke in Code Stroke. Analysis of diagnostic prediction models.

Macias-Gómez

Suárez-Pérez

Rodríguez-Campello

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Differences between migraine with aura (MA) mimicking stroke and ischemic strokes were analyzed to create a predictive diagnostic model.Methods: Prospective cohort of code strokes attended between January 2005 and June 2020 in a tertiary hospital evaluated by a vascular neurologist. Data recorded included: Place of activation, demographics, vascular risk factors, vitals, initial blood test (glucose, blood count, electrolytes, coagulation times, D-dimer, fibrinogen and C-reactive protein), initial NIHSS, door-to-onset time, and door-to-needle time. After the vascular study, diagnosis of ischemic stroke or MA was registered. Multivariate logistic regression analyses were performed to create a predictive model. Discrimination and calibration performance were assessed. A secondary aim was to describe detailed clinical and radiological data of MA cases in order to identify new predictive factors that could be used in future studies.Results: Of 3140 code strokes attended, 2424 (77.2%) were ischemic strokes and 34 (1.1%) were MA. Migraine cases were younger, more frequently females and with low prevalence of vascular risk factors. Initial NIHSS was lower in MA cases, but no differences were seen in fibrinolysis rate (30%). Blood test showed lower levels of glucose, D-dimer, and fibrinogen in MA cases. Multivariate model showed and independent association for ischemic stroke with age [OR, (95%CI):1.09, (1.07-1.12, p<0.001], male sex [OR, (95%CI):4.47, (3.80-5.13), p<0.001], initial NIHSS [OR, (95%CI):1.21, (1.07-1.34), p<0.01], and fibrinogen levels [OR, (95%CI):1.01, (1.00-1.01), p<0.05]. A model including sex and cut-off points (age>65, NIHSS>6, and fibrinogen>400mg/dL) showed a good global discrimination capacity (AUC = 0.897) but a good calibration only for extreme predicted probabilities (>98% in ischemic strokes or < 10% in MA). We did not find any differential clinical or radiological factor that could be exclusive of MA.Conclusions: A predictive model including age >65, men sex, NIHSS >6 and fibrinogen >400 mg/dL showed a good discrimination, but low calibration performance to distinguish between MA and ischemic stroke. Future studies should involve migraine biomarkers in order to improve clinical decision making.

show abstract

Section: Discussionsupporting

confidence: 74%

Migraine Aura mimicking Stroke in Code Stroke. Analysis of diagnostic prediction models.

Macias-Gómez

Suárez-Pérez

Rodríguez-Campello

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…When symptoms are prolonged, suspect hemiplegic migraine. Imaging, including DWI-MRI, is normal [80].…”

Section: Migraine Presentationmentioning

confidence: 99%

Stroke mimics: incidence, aetiology, clinical features and treatment

et al. 2021

View full text Add to dashboard Cite

Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

show abstract

“…Individuals with migraine report changes in speech during migraine attacks and several studies have documented speech difficulty during the aura phase of the attack as well as prior to and during the attack [1][2][3]. Although severe alterations in speech are easily observed, objective methods for assessing subtle changes in speech production in subjects with headache remain sparse.…”

Section: Introductionmentioning

confidence: 99%

Altered speech patterns in subjects with post-traumatic headache due to mild traumatic brain injury

Chong

Zhang

et al. 2021

J Headache Pain

View full text Add to dashboard Cite

Background/objective Changes in speech can be detected objectively before and during migraine attacks. The goal of this study was to interrogate whether speech changes can be detected in subjects with post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) and whether there are within-subject changes in speech during headaches compared to the headache-free state. Methods Using a series of speech elicitation tasks uploaded via a mobile application, PTH subjects and healthy controls (HC) provided speech samples once every 3 days, over a period of 12 weeks. The following speech parameters were assessed: vowel space area, vowel articulation precision, consonant articulation precision, average pitch, pitch variance, speaking rate and pause rate. Speech samples of subjects with PTH were compared to HC. To assess speech changes associated with PTH, speech samples of subjects during headache were compared to speech samples when subjects were headache-free. All analyses were conducted using a mixed-effect model design. Results Longitudinal speech samples were collected from nineteen subjects with PTH (mean age = 42.5, SD = 13.7) who were an average of 14 days (SD = 32.2) from their mTBI at the time of enrollment and thirty-one HC (mean age = 38.7, SD = 12.5). Regardless of headache presence or absence, PTH subjects had longer pause rates and reductions in vowel and consonant articulation precision relative to HC. On days when speech was collected during a headache, there were longer pause rates, slower sentence speaking rates and less precise consonant articulation compared to the speech production of HC. During headache, PTH subjects had slower speaking rates yet more precise vowel articulation compared to when they were headache-free. Conclusions Compared to HC, subjects with acute PTH demonstrate altered speech as measured by objective features of speech production. For individuals with PTH, speech production may have been more effortful resulting in slower speaking rates and more precise vowel articulation during headache vs. when they were headache-free, suggesting that speech alterations were related to PTH and not solely due to the underlying mTBI.

show abstract

Migraine with Aura as a Stroke Mimic

Cited by 11 publications

References 12 publications

Migraine Aura mimicking Stroke in Code Stroke. Analysis of diagnostic prediction models.

Migraine Aura mimicking Stroke in Code Stroke. Analysis of diagnostic prediction models.

Stroke mimics: incidence, aetiology, clinical features and treatment

Altered speech patterns in subjects with post-traumatic headache due to mild traumatic brain injury

Contact Info

Product

Resources

About