![]() In this context, BEUM described in this case could be considered as a possible aura. Uncommon aura presentations are listed in Table 1. ![]() These symptoms, because of their modality of presentation, recurrence, length, and the negativity of physical and instrumental examinations, could be considered as “aura phenomena”. In clinical practice, other symptoms not particularly rare, and in the past classified as “migraine equivalents”, are considered as the borderland of migrainous auras such as recurrent abdominal pain, cyclic vomiting, vertigo, and transient global amnesia. Much less common symptoms include gustatory, olfactory, or auditory (oscillocusis) hallucinations and higher mental function disorders, such as confusional states particularly seen in children, temporal lobe phenomena, agraphia, and alien hand. The MA is characterized by recurrent episodes of transient focal neurologic dysfunction visual aura is the most frequent symptoms, followed by sensory, aphasic, and motor auras. Patient’s mother was affected by migraine without aura.Īt the follow-up, the patient continues to report his usual, above described, MA attacks, headache being treated successfully with NSAIDs or triptans. It lasted approximately 6 h, accompanied by photophobia, phonophobia, occasional nausea without vomiting, and was responsive to NSAIDs and triptans. The pain was described as severe, alternating unilateral and pulsating. The headache began almost immediately after resolution of the visual symptoms. They affected the left visual field, developing from the periphery in 5–10 min and lasting 20–30 min. He described the auras as small, translucent, gray-colored spots, similar to those which occur after looking at a bright light. The first visual aura appeared 3 years later, approximately 3–4 months after the last BEUM: this latter never occurred after the appearance of MA. It was not possible to examine the patient during the attacks since BEUM did not last more than 30 min. The ophthalmologic examination including the visual field yielded normal findings as did the physical and neurologic examinations. The intraocular eye pressure was normal bilaterally, and the visual acuity was 20/20. He underwent a complete blood screening, gadolinium-enhanced magnetic resonance imaging of the brain and neck, extracranial and transcranial Doppler ultrasound, electroencephalography, and transthoracic echocardiography, all of which were normal. Blurring of the vision developed and resolved gradually in 5–10 min. The frequency was regular and occurred about monthly for approximately 3 years. This sign lasted between 5 and 30 min, and was immediately followed by a slight, nonthrobbing, diffuse headache lasting about 3–4 h, without any other symptom or sign. In those instances, viewing himself in the mirror, he noticed that the left pupil was larger than the right pupil, with normal reactivity to light. The patient reported that 7 years before he had suffered for 3 years of transitory episodic blurring of the vision, always in the left eye. A 24-year-old man presented to our headache center with a 4-year history of MA (ICHD-II criteria).
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