Aura (symptom)

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Aura is the perceptual disturbance experienced by some migraine sufferers before a migraine headache, and the telltale sensation experienced by some people with epilepsy before a seizure. It often manifests as the perception of a strange light or an unpleasant smell.

An aura does not necessitate the onset of either a migraine or a seizure and not everyone who suffers from migraines or seizures will experience auras. Though auras tend to be an unpleasant and irritating sensation, they can be beneficial. Most injuries from seizures occur when there is no warning. Auras allow epileptics time to prevent injury to themselves. The time between the appearance of the aura and the onset of a migraine or seizure can be anything from a few seconds up to an hour. Most people who have auras have the same type of aura every time.

• Auras can take on the following forms:

  • Auditory
  • Sensory
  • Visual

• Auras can also be described as having odd odors, deja vu or dreamlike sensations
• Can possibly be attributed to the area of the brain involved

Complete Differential Diagnosis of the Causes of Aura (symptom)

(In alphabetical order)

• Absence seizures
• Color blindness
• Complex partial seizure
• Epilepsy
• Familial hemiplegic migraine
• Focal seizures
• Gluten-sensitive enteropathy associated conditions
• Migraine
• Partial seizure
• Physiologic nonepileptic seizures
• Pituitary adenoma
• Simple partial seizure
• Temporal lobe epilepsy
• Tonic-clonic seizure

Complete Differential Diagnosis of the Causes of Aura (symptom)

(By organ system)

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Pituitary adenoma
Environmental	No underlying causes
Gastroenterologic	Gluten-sensitive enteropathy associated conditions
Genetic	Color blindness
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	Absence seizures, Complex partial seizure, Focal seizures, Partial seizure, Physiologic nonepileptic seizures, Simple partial seizure, Tonic-clonic seizure, Epilepsy, Familial hemiplegic migraine, Migraine, Temporal lobe epilepsy, Pituitary adenoma
Nutritional / Metabolic	Gluten-sensitive enteropathy associated conditions
Obstetric/Gynecologic	No underlying causes
Oncologic	Pituitary adenoma
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

History and Symptoms

• History very important

  • Type (aura)
  • Family history
  • Associated activities
  • Triggers

• Symptoms postaura

  • Loss of consciousness
  • Prior trauma

Physical Examination

• Complete head and neck exam

Neurologic

• Complete neurologic exam

Laboratory Findings

• Complete blood count (CBC)
• Calcium
• Magnesium
• Glucose
• Blood urea nitrogen (BUN) / creatinine

Electrolyte and Biomarker Studies

• Electrolytes

MRI and CT

• CT for trauma of physiologic seizure
• MRI rules out cerebral pathology

Other Imaging Findings

• Electroencephalogram (EEG) for seizure activity

Other Diagnostic Studies

• Toxicology screen

Treatment

• Avoidance of triggers (migraines)
• Stabilize patients with status epilepticus

Pharmacotherapy

Acute Pharmacotherapies

• NSAIDs (nonsteriodal anti-inflammatory drugs) (migraines)
• 5-HT1 agonists (migraines)
• Acetaminophen (migraines)
• IV benzodiazepines (epilepsy)
• Antiepileptics (epilepsy)

An aura sensation can include:

• Visual Changes.
  • Bright lights.
  • Zigzag lines.
  • Distortions in the size or shape of object.
  • scintillating scotoma
    • Shimmering, pulsating patches, often curved.
    • Tunnel Vision
  • scotoma
    • Blind or dark spots in the field of vision.
    • Curtain like effect over one eye.
    • Slowly spreading spots.
  • Kaleidescope effects on visual field
  • Total temporary monocular (in one eye) blindness. (in retinal migraine)
• Auditory changes
  • Hearing voices or sounds that don't exist: true auditory hallucinations.
  • Modification of voices or sounds in the environment: buzzing, tremolo, amplitude modulation or other modulations.
• Strange smells (olfactory hallucinations).
• Feelings of numbness or tingling on one side of the face or body.
• Feeling separated from one's body.
• Feeling as if your limbs are moving independently from your body.
• Anxiety or fear.
• Nausea.
• Weakness, unsteadiness.
• Being unable to understand or comprehend spoken words during and after the aura.
• Being unable to speak properly, despite your brain grasping what you're trying to verbalize. (Aphasia)
• Feeling of power or sense of euphoria (this symptom has been associated with discontinuation of seizure treatments - the sufferer may enjoy the experience and think it worth the seizure or migraine that follows)

The specific type of sensation associated with an aura can potentially be used in an attempt to localize the focus of a seizure.

Auras share similar symptoms with strokes, but onset is more gradual with auras.

See also

• Hallucination
• Paresthesia
• Synesthesia
• Simple partial seizure
• Complex partial seizure

External links

• About.com aura summary
• Epilepsy.com information
• Migraine Aura Foundation
• MAGNUM, the National Migraine Association
• Epilepsy Action information
• Migraines with 'aura' raise women's stroke risk