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Migraine Aura Without Headache Versus Transient Ischemic Attack During Pregnancy
Author(s) -
Evans Randolph W.,
Rothrock John F.
Publication year - 2001
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1046/j.1526-4610.2001.111006414.x
Subject(s) - migraine , aura , medicine , psychiatry , psychology
CLINICAL HISTORY A 30-year-old woman, gravida 1, was seen at 37 weeks’ gestation for evaluation of an episode of visual loss and paresthesias. The evening prior, the patient had a moderate, bifrontal, aching, and throbbing headache without associated symptoms. She took acetaminophen, went to bed, and the headache was gone in the morning. Later that morning, she felt stressed. She developed blurred vision in the left visual field with a scotoma lasting about 30 minutes. One hour later, she had tingling of the left side of the lips for 10 minutes, followed by numbness of the left thumb and index finger spreading to all the fingers which also resolved within 10 minutes. She had no further headaches and felt fine. There was a history of a severe headache with light sensitivity 6 years previously lasting about 1 day after her father died. Otherwise, she had occasional mild headaches without associated symptoms. Past medical history was otherwise unremarkable. She does not smoke. Blood pressure was 100/70 mm Hg. Neurologic examination was normal. Urine was negative for protein. An MRI of the brain with magnetic resonance angiography (MRA) of the brain and neck and intracranial magnetic resonance venography (MRV) were normal. An ECG and 2D echocardiogram were normal. The following blood studies were normal: complete blood count with platelets, prothrombin time, partial thromboplastin time, chemistry profile, antinuclear antibodies, rheumatoid factor, lupus anticoagulant, anticardiolipin antibodies, protein C, and protein S. An erythrocyte sedimentation rate was 55 mm/hr (frequently elevated during pregnancy). Questions.— Was this episode due to migraine? Can you reliably distinguish between the presentation of a migraine aura and a transient ischemic attack (TIA)? Was the diagnostic testing indicated?