Aura (symptom) explained

Aura
Field:Neurology, neuro-ophthalmology
Types:Scintillating scotoma
Differential:Persistent aura without infarction, retinal migraine, visual snow

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure.[1]

Epileptic and migraine auras are due to the involvement of specific areas of the brain, which are those that determine the symptoms of the aura. Therefore, if the visual area is affected, the aura will consist of visual symptoms, while if a sensory one, then sensory symptoms will occur.

Epileptic auras are subjective sensory or psychic phenomena due to a focal seizure, i.e. a seizure that originates from that area of the brain responsible for the function which then expresses itself with the symptoms of the aura. It is important because it makes it clear where the alteration causing the seizure is located. An epileptic aura is in most cases followed by other manifestations of a seizure, for example a convulsion, since the epileptic discharge spreads to other parts of the brain. Rarely it remains isolated. Auras, when they occur, allow some people who have epilepsy time to prevent injury to themselves and/or others when they lose consciousness.

Migraine

The aura of migraine is visual in the vast majority of cases, because dysfunction starts from the visual cortex. The aura is usually followed, after a time varying from minutes to an hour, by the migraine headache. However, the migraine aura can manifest itself in isolation, that is, without being followed by headache. The aura can stay for the duration of the migraine; depending on the type of aura, it can leave the person disoriented and confused. It is common for people with migraines to experience more than one type of aura during the migraine. Some people who have auras have the same type of aura every time.

Auras can also be confused with sudden onset of panic, panic attacks or anxiety attacks, which creates difficulties in diagnosis. The differential diagnosis of patients who experience symptoms of paresthesias, derealization, dizziness, chest pain, tremors, and palpitations can be quite challenging.[2]

Seizures

An epileptic aura is the consequence of the activation of functional cortex by abnormal neuronal discharge.[3] In addition to being a warning sign for an impending seizure, the nature of an aura can give insight into the localization and lateralization of the seizure or migraine.[4] [5]

The most common auras include motor, somatosensory, visual, and auditory symptoms.[6] The activation in the brain during an aura can spread through multiple regions continuously or discontinuously, on the same side or to both sides.[7]

Auras are particularly common in focal seizures. If the motor cortex is involved in the overstimulation of neurons, motor auras can result. Likewise, somatosensory auras (such as tingling, numbness, and pain) can result if the somatosensory cortex is involved. When the primary somatosensory cortex is activated, more discrete parts on the opposite side of the body and the secondary somatosensory areas result in symptoms ipsilateral to the seizure focus.[8] [9]

Visual auras can be simple or complex. Simple visual symptoms can include static, flashing, or moving lights/shapes/colors caused mostly by abnormal activity in the primary visual cortex. Complex visual auras can include people, scenes, and objects which results from stimulation of the temporo-occipital junction and is lateralized to one hemifield. Auditory auras can also be simple (ringing, buzzing) or complex (voices, music). Simple symptoms can occur from activation in the primary auditory cortex and complex symptoms from the temporo-occipital cortex at the location of the auditory association areas.[10]

Examples

An aura sensation can include one or a combination of the following:

Visual changes

Auditory changes

Other sensations

Notes and References

  1. https://epilepsysociety.org.uk/epilepsy-auras Epilepsy auras
  2. Hurley . Robin A. . Fisher . Ronald . Taber . Katherine H. . Sudden Onset Panic: Epileptic Aura or Panic Disorder? . The Journal of Neuropsychiatry and Clinical Neurosciences . 1 October 2006 . 18 . 4 . 436–443 . 10.1176/jnp.2006.18.4.436. 17135371 . free .
  3. Perven G and So NK. 2015 . Epileptic auras: phenomenology and neurophysiology. . Epileptic Disorders . 17 . 4. 549–562 . 10.1684/epd.2015.0786 . 26643374 .
  4. Ye. Byoung Seok. Cho. Yang-Je. Jang. Sang Hyun. Lee. Moon Kyu. Lee. Byung In. Heo. Kyoung. 2012-05-01. The Localizing and Lateralizing Value of Auras in Lesional Partial Epilepsy Patients. Yonsei Medical Journal. 53. 3. 477–485. 10.3349/ymj.2012.53.3.477. 3343447. 22476989.
  5. February 2011. Localizing and lateralizing features of auras and seizures. 20926350 . Foldvary-Schaefer. N.. Unnwongse. K.. Epilepsy & Behavior . 20. 2. 160–166. 10.1016/j.yebeh.2010.08.034. 1220765.
  6. Sharma S., Dixit V. . 2013 . Epilepsy – A Comprehensive Review . International Journal of Pharmacological Research & Review . 2 . 12. 61–80 .
  7. Tuxhorn I. E. B. . 2005 . Somatosensory auras in focal epilepsy: A clinical, video EEG and MRI study . Seizure: European Journal of Epilepsy . 14 . 4. 262–268 . 10.1016/j.seizure.2005.02.005. 15911361 . 18386228 . free .
  8. Tuxhorn. I. E. B.. 2005-06-01. Somatosensory auras in focal epilepsy: A clinical, video EEG and MRI study. Seizure. en. 14. 4. 262–268. 10.1016/j.seizure.2005.02.005. 15911361. 18386228. free.
  9. November 1995. Association of ipsilateral head turning and dystonia in temporal lobe seizures. 7588449 . Fakhoury. T.. Abou-Khalil. B.. Epilepsia. 36. 11. 1065–1070. 10.1111/j.1528-1157.1995.tb00463.x. 35063423.
  10. Foldvary-Schaefer . Nancy . Unnwongse . Kanjana . Localizing and lateralizing features of auras and seizures . Epilepsy & Behavior . 1 February 2011 . 20 . 2 . 160–166 . 10.1016/j.yebeh.2010.08.034. 20926350 . 1220765 .
  11. Web site: Aura: Migraine's Odd Companion. 2021-03-17. Migraineur. 20 February 2018 . en-US.
  12. Web site: Patient's Guide to Visual Migraine - Brigham and Women's Hospital. 2021-03-17. www.brighamandwomens.org.
  13. Web site: Alice in Wonderland Syndrome - an overview ScienceDirect Topics. 2022-01-11. www.sciencedirect.com.
  14. Web site: OD. By George T. Banyas. Visual Aura and Scotomas: What Do They Indicate?. 2022-01-11. www.reviewofoptometry.com.
  15. Web site: Liao. Sharon. Causes of Temporary Blindness and Short-Term Vision Loss. 2022-01-11. WebMD. en.
  16. Web site: 2021-08-16. Photophobia: Causes, symptoms, and treatment. 2022-01-11. www.medicalnewstoday.com. en.
  17. Web site: DiLonardo. Mary Jo. Epilepsy: What is Seizure With Aura?. 2022-01-11. WebMD. en.
  18. van der Feltz-Cornelis. Christina M. Biemans. Henk. Timmer. Jan. 2012. Hearing voices: does it give your patient a headache? A case of auditory hallucinations as acoustic aura in migraine. Neuropsychiatric Disease and Treatment. 8. 105–111. 10.2147/NDT.S29300. 3333787. 22536065 . free .
  19. 16 April 2018. Subclinical vestibular dysfunction in migraineurs without vertigo. Acta Neurologica Scandinavica. 29658983. Bernetti. L.. Pellegrino. C.. Corbelli. I.. Caproni. S.. Eusebi. P.. Faralli. M.. Ricci. G.. Calabresi. P.. Sarchielli. P.. 138. 4. 270–277. 10.1111/ane.12941. 4887561. free.
  20. 22 August 2016. Phantosmia and Migraine With and Without Headache. Headache. 27545897. Jion. Y. I.. Grosberg. B. M.. Evans. R. W.. 56. 9. 1494–1502. 10.1111/head.12890. 36091982.
  21. Web site: Can Being Sensitive to Smells Impact Migraine?. 2022-01-11. www.excedrin.com. en-US.
  22. Synesthetic associations and psychosensory symptoms of temporal epilepsy . Marcel Neckar . Petr Bob . 11 January 2016 . Neuropsychiatric Disease and Treatment . 4714732 . 26811683 . 10.2147/NDT.S95464 . 12 . 109–12 . free .
  23. Adachi. Naoto. Akanuma. Nozomi. Ito. Masumi. Adachi. Takuya. Takekawa. Yoshikazu. Adachi. Yasushi. Matsuura. Masato. Kanemoto. Kousuke. Kato. Masaaki. 2010-07-01. Two forms of deja vu experiences in patients with epilepsy. Epilepsy & Behavior. 18. 3. 218–22. 10.1016/j.yebeh.2010.02.016. 20494621. 27034245.
  24. August 2014. Cephalic aura after frontal lobe resection. 4340243. Kakisaka. Y.. Jehi. L.. Alkawadri. R.. Wang. Z. I.. Enatsu. R.. Mosher. J. C.. Dubarry. A. S.. Alexopoulos. A. V.. Burgess. R. C.. Journal of Clinical Neuroscience . 21. 8. 1450–1452. 10.1016/j.jocn.2013.11.024. 24613491.
  25. Web site: Hoffman. Matthew. MD. Abdominal Epilepsy in Children and Adults. 2022-01-11. WebMD. en.
  26. December 2007. Ictal nausea with vomiting as the major symptom of simple partial seizures. Epilepsy & Behavior . 18054131. Sekimoto. M.. Kato. M.. Kaneko. Y.. Onuma. T.. 11. 4. 582–587. 10.1016/j.yebeh.2007.08.023. 45291893.
  27. Somatosensory auras in refractory temporal lobe epilepsy. Epilepsia. 2006. 16417550. Erickson. J. C.. Clapp. L. E.. Ford. G.. Jabbari. B.. 47. 1. 202–206. 10.1111/j.1528-1167.2006.00388.x. 25666352. free.
  28. Web site: 2019-05-17. Dissociation and depersonalization: Causes, risk factors, and symptoms. 2022-01-11. www.medicalnewstoday.com. en.
  29. Web site: Brain & Spine Foundation Migraine. 2022-01-11. en.
  30. Web site: Recognizing Aphasia During a Migraine Attack. 2022-01-11. www.northsuffolkneurology.com. en-US.

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