Clinical characteristics of definite persistent aura

b c c runner [subject #73], Visual snow, 2006. © 2006 b c c runner [more]

Technicolor [subject #283], Visual static, 2007. © 2007 Technicolor [more]

"Your and your co-workers' work in gathering data on this condition by Sofia Greene's internet survey", wrote David C. Haas in a personal communication to the senior author, "should enlarge and deepen the clinical picture of this condition. Identifying its occurrence within families is an important contribution, not previously described, to my knowledge... Your observations on patients with recurrent attacks [of persistent aura] doesn't surprise me at all, because all migrainous phenomena are extremely varied... I had little personal contact with patients with persistent aura beyond the two that I published. I did hear from at least 20 via e-mail when my Web text was up, but I don't recall any stating they had had prior attacks. Analysing the brains of patients during and after prolonged attacks with fMRI might give clues about gross brain processes during attacks."

(David C. Haas, Email to Klaus Podoll, June 7, 2006; additions in square brackets by Klaus Podoll)

Sofia Greene [subject #1], Radiator and zebra print curtains, 2006. © 2006 Sofia Greene [more]

Sofia Greene [subject #1], Afterimage of zebra print curtains whilst looking down at the radiator, 2006. © 2006 Sofia Greene [more]

In addition to clinical variables such as sex and age distribution, history and family history of migraine, the following webpages describe the symptoms and course of persistent aura in a group of 60 participants in Sofia Greene's internet survey (subjects #1, #8, #14, #20, #23, #30, #42, #45, #52, #73, #75, #80, #85, #86, #104, #120, #136, #138, #141, #142, #145, #147, #152, #153, #156, #157, #159, #162, #167, #168, #169, #171, #172, #175, #179, #180, #182, #185, #189, #200, #217, #228, #230, #233, #234, #235, #240, #254, #257, #258, #264, #265, #273, #276, #277, #283, #284, #296, #300, #301) who were given a suspected diagnosis of definite persistent aura without infarction according to the diagnostic criteria used in this study. This sample represents the largest group of sufferers from this migraine complication ever assembled and has allowed us to study the clinical picture of this condition in unprecedented detail. Based on the clinical data from this sample, persistent aura without infarction can be identified as a complication of predominantly basilar-type migraine. A review of the findings from medical tests and a discussion of the diagnoses and misdiagnoses made by primary or secondary care doctors concludes the portrayal of the clinical characteristics of definite persistent aura without infarction. Worsening and improving factors of the intensity of persistent aura symptoms will be dealt with in separate sections, gathering together the data from the three groups of subjects diagnosed as having definite, probable or possible persistent aura without infarction, respectively.

In 33 of the 60 subjects (#1, #14, #20, #23, #30, #42, #52, #73, #75, #85, #86, #138, #142, #145, #156, #159, #162, #167, #168, #169, #171, #172, #180, #182, #185, #189, #200, #233, #254, #264, #276, #277, #301) with a suspected diagnosis of definite persistent aura without infarction, their doctors made diagnoses explicitly attributing their persisting perception disorder to migraine either before (subjects #1, #14, #20, #23, #30, #52, #73, #75, #85, #86, #142, #145, #156, #167, #168, #169, #171, #172, #180, #182, #185, #200, #254, #264, #276, #277, #301) or after (subjects #42, #138, #159, #162, #189, #233) the subjects' participation in Sofia Greene's internet survey, providing supportive evidence for the validity of the diagnosis made in this study. In 8 of the 60 subjects, it was possible to obtain copies of medical records from doctors who had confirmed the diagnosis of persistent aura in subjects from this group either before (subjects #1, #23, #156, #264) or after (subjects #138, #159, #162, #189) their participation in Sofia Greene's internet survey. These medical records are important as external validation of the diagnoses by internet made in the present sample of subjects.

Aachen, Germany (see here).

Three subjects (#45, #85, #171) from Germany and the UK, respectively, visited the senior author for migraine consultation in his office at the University Hospital Aachen, Medical Faculty RWTH, Germany. In all 3 cases, the history-taking and neurological as well as psychiatric examination confirmed the medical history obtained before via internet survey and subsequent email correspondence and the diagnoses based thereupon. In one of these cases (subject #45), the diagnosis by internet of probable persistent aura could be changed into definite persistent aura on the grounds of the additional information obtained during the personal examination.

References

International Headache Society. The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004; 24 (suppl. 1): 1-160.

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