aura (symptom)

{{Infobox medical condition (new)

| name = Aura

| synonyms =

| image = Migraine aura.jpg

| caption = Artist's depiction of zig-zag lines experienced as part of a migraine aura phenomenon

| pronounce =

| field = Neurology, neuro-ophthalmology

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| duration =

| types = Scintillating scotoma

| causes =

| risks =

| diagnosis =

| differential = Persistent aura without infarction, retinal migraine, visual snow

| prevention =

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An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure.{{Cite web |url=https://epilepsysociety.org.uk/epilepsy-auras |title=Epilepsy auras |access-date=2021-03-14 |archive-date=2021-06-24 |archive-url=https://web.archive.org/web/20210624202001/https://epilepsysociety.org.uk/epilepsy-auras |url-status=dead }}

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.{{cite journal |last1=Hurley |first1=Robin A. |last2=Fisher |first2=Ronald |last3=Taber |first3=Katherine H. |title=Sudden Onset Panic: Epileptic Aura or Panic Disorder? |journal=The Journal of Neuropsychiatry and Clinical Neurosciences |date=1 October 2006 |volume=18 |issue=4 |pages=436–443 |doi=10.1176/jnp.2006.18.4.436|pmid=17135371 |doi-access=free }}

Seizures

An epileptic aura is the consequence of the activation of functional cortex by abnormal neuronal discharge.{{cite journal | author = Perven G and So NK| year = 2015 | title = Epileptic auras: phenomenology and neurophysiology. | journal = Epileptic Disorders | volume = 17 | issue = 4| pages = 549–562 | doi = 10.1684/epd.2015.0786 | pmid = 26643374 }} 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.{{Cite journal|last1=Ye|first1=Byoung Seok|last2=Cho|first2=Yang-Je|last3=Jang|first3=Sang Hyun|last4=Lee|first4=Moon Kyu|last5=Lee|first5=Byung In|last6=Heo|first6=Kyoung|date=2012-05-01|title=The Localizing and Lateralizing Value of Auras in Lesional Partial Epilepsy Patients|journal=Yonsei Medical Journal|volume=53|issue=3|pages=477–485|doi=10.3349/ymj.2012.53.3.477|pmc=3343447|pmid=22476989}}{{Cite journal|date=February 2011|title=Localizing and lateralizing features of auras and seizures|pmid=20926350 |last1=Foldvary-Schaefer|first1=N.|last2=Unnwongse|first2=K.|journal=Epilepsy & Behavior |volume=20|issue=2|pages=160–166|doi=10.1016/j.yebeh.2010.08.034|s2cid=1220765}}

The most common auras include motor, somatosensory, visual, and auditory symptoms.{{cite journal | author = Sharma S., Dixit V. | year = 2013 | title = Epilepsy – A Comprehensive Review | journal = International Journal of Pharmacological Research & Review | volume = 2 | issue = 12| pages = 61–80 }} The activation in the brain during an aura can spread through multiple regions continuously or discontinuously, on the same side or to both sides.{{cite journal | author = Tuxhorn I. E. B. | year = 2005 | title = Somatosensory auras in focal epilepsy: A clinical, video EEG and MRI study | journal = Seizure: European Journal of Epilepsy | volume = 14 | issue = 4| pages = 262–268 | doi=10.1016/j.seizure.2005.02.005| pmid = 15911361 | s2cid = 18386228 | doi-access = free }}

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.{{Cite journal|last=Tuxhorn|first=I. E. B.|date=2005-06-01|title=Somatosensory auras in focal epilepsy: A clinical, video EEG and MRI study|journal=Seizure|language=en|volume=14|issue=4|pages=262–268|doi=10.1016/j.seizure.2005.02.005|pmid=15911361|s2cid=18386228|doi-access=free}}{{Cite journal|date=November 1995|title=Association of ipsilateral head turning and dystonia in temporal lobe seizures|pmid=7588449 |last1=Fakhoury|first1=T.|last2=Abou-Khalil|first2=B.|journal=Epilepsia|volume=36|issue=11|pages=1065–1070|doi=10.1111/j.1528-1157.1995.tb00463.x|s2cid=35063423}}

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.{{cite journal |last1=Foldvary-Schaefer |first1=Nancy |last2=Unnwongse |first2=Kanjana |title=Localizing and lateralizing features of auras and seizures |journal=Epilepsy & Behavior |date=1 February 2011 |volume=20 |issue=2 |pages=160–166 |doi=10.1016/j.yebeh.2010.08.034|pmid=20926350 |s2cid=1220765 }}

Examples

File:aura ss.jpg

File:ScintillatingScotoma3.jpg

File:Migraine-aura-aka-scintillating-scotoma-anecdoteal-depiction.png

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

=Visual changes=

Bright lights and blobs{{Cite web|title=Aura: Migraine's Odd Companion|url=https://www.migraineurmagazine.com/migraineur/aura-migraine-odd-companion|access-date=2021-03-17|website=Migraineur|date=20 February 2018 |language=en-US}}
Zigzag lines{{Cite web|title=Patient's Guide to Visual Migraine - Brigham and Women's Hospital|url=https://www.brighamandwomens.org/neurology/neuro-ophthalmology/visual-migraine#:~:text=A%20visual%20migraine%20is%20a,minutes%20and%20then%20completely%20resolve.|access-date=2021-03-17|website=www.brighamandwomens.org}}
Distortions in the size or shape of objects{{Cite web|title=Alice in Wonderland Syndrome - an overview {{!}} ScienceDirect Topics|url=https://www.sciencedirect.com/topics/medicine-and-dentistry/alice-in-wonderland-syndrome|access-date=2022-01-11|website=www.sciencedirect.com}}
Vibrating visual field
Scintillating scotoma
Shimmering, pulsating patches, often curved
Tunnel vision
Scotoma{{Cite web|last=OD|first=By George T. Banyas|title=Visual Aura and Scotomas: What Do They Indicate?|url=https://www.reviewofoptometry.com/article/visual-aura--and-scotomas-what-do-they-indicate|access-date=2022-01-11|website=www.reviewofoptometry.com}}
Blind or dark spots
Curtain like effect over one eye
Slowly spreading spots
Kaleidoscope effects
Temporary blindness in one or both eyes{{Cite web|last=Liao|first=Sharon|title=Causes of Temporary Blindness and Short-Term Vision Loss|url=https://www.webmd.com/eye-health/temporary-blindness-short-term-vision-loss|access-date=2022-01-11|website=WebMD|language=en}}
Heightened sensitivity to light{{Cite web|date=2021-08-16|title=Photophobia: Causes, symptoms, and treatment|url=https://www.medicalnewstoday.com/articles/photophobia|access-date=2022-01-11|website=www.medicalnewstoday.com|language=en}}

=Auditory changes=

Hearing voices or sounds that do not exist: auditory hallucinations{{Cite web|last=DiLonardo|first=Mary Jo|title=Epilepsy: What is Seizure With Aura?|url=https://www.webmd.com/epilepsy/seizure-with-aura|access-date=2022-01-11|website=WebMD|language=en}}
Modification of voices or sounds in the environment: buzzing, tremolo, amplitude modulation or other modulations
Heightened sensitivity to hearing{{Cite journal|last1=van der Feltz-Cornelis|first1=Christina M|last2=Biemans|first2=Henk|last3=Timmer|first3=Jan|date=2012|title=Hearing voices: does it give your patient a headache? A case of auditory hallucinations as acoustic aura in migraine|journal=Neuropsychiatric Disease and Treatment|volume=8|pages=105–111|doi=10.2147/NDT.S29300|pmc=3333787|pmid=22536065 |doi-access=free }}
Vestibular dysfunction causing vertigo{{Cite journal|date=16 April 2018|title=Subclinical vestibular dysfunction in migraineurs without vertigo|journal=Acta Neurologica Scandinavica|pmid=29658983|last1=Bernetti|first1=L.|last2=Pellegrino|first2=C.|last3=Corbelli|first3=I.|last4=Caproni|first4=S.|last5=Eusebi|first5=P.|last6=Faralli|first6=M.|last7=Ricci|first7=G.|last8=Calabresi|first8=P.|last9=Sarchielli|first9=P.|volume=138|issue=4|pages=270–277|doi=10.1111/ane.12941|s2cid=4887561|doi-access=free}}

=Other sensations=

Strange smells (phantosmia) or tastes (gustatory hallucinations){{Cite journal|date=22 August 2016|title=Phantosmia and Migraine With and Without Headache|journal=Headache|pmid=27545897|last1=Jion|first1=Y. I.|last2=Grosberg|first2=B. M.|last3=Evans|first3=R. W.|volume=56|issue=9|pages=1494–1502|doi=10.1111/head.12890|s2cid=36091982}}
Heightened sensitivity to smell{{Cite web|title=Can Being Sensitive to Smells Impact Migraine?|url=https://www.excedrin.com/migraines/causes/can-smells-cause-migraines/|access-date=2022-01-11|website=www.excedrin.com|language=en-US}}
Synesthesia{{cite journal |title=Synesthetic associations and psychosensory symptoms of temporal epilepsy |author1=Marcel Neckar |author2=Petr Bob |date=11 January 2016 |journal= Neuropsychiatric Disease and Treatment |pmc=4714732 |pmid=26811683 |doi=10.2147/NDT.S95464 |volume=12 |pages=109–12 |doi-access=free }}
Déjà vu or jamais vu{{Cite journal|last1=Adachi|first1=Naoto|last2=Akanuma|first2=Nozomi|last3=Ito|first3=Masumi|last4=Adachi|first4=Takuya|last5=Takekawa|first5=Yoshikazu|last6=Adachi|first6=Yasushi|last7=Matsuura|first7=Masato|last8=Kanemoto|first8=Kousuke|last9=Kato|first9=Masaaki|date=2010-07-01|title=Two forms of deja vu experiences in patients with epilepsy|journal=Epilepsy & Behavior|volume=18|issue=3|pages=218–22|doi=10.1016/j.yebeh.2010.02.016|pmid=20494621|s2cid=27034245}}
Cephalic aura, a perception of movement of the head or inside the head{{Cite journal|date=August 2014|title=Cephalic aura after frontal lobe resection|pmc=4340243|last1=Kakisaka|first1=Y.|last2=Jehi|first2=L.|last3=Alkawadri|first3=R.|last4=Wang|first4=Z. I.|last5=Enatsu|first5=R.|last6=Mosher|first6=J. C.|last7=Dubarry|first7=A. S.|last8=Alexopoulos|first8=A. V.|last9=Burgess|first9=R. C.|journal=Journal of Clinical Neuroscience |volume=21|issue=8|pages=1450–1452|doi=10.1016/j.jocn.2013.11.024|pmid=24613491}}
Abdominal aura, such as an epigastric rising sensation{{Cite web|last1=Hoffman|first1=Matthew|last2=MD|title=Abdominal Epilepsy in Children and Adults|url=https://www.webmd.com/epilepsy/guide/abdominal-epilepsy-in-children-and-adults|access-date=2022-01-11|website=WebMD|language=en}}
Nausea{{Cite journal|date=December 2007|title=Ictal nausea with vomiting as the major symptom of simple partial seizures|journal=Epilepsy & Behavior |pmid=18054131|last1=Sekimoto|first1=M.|last2=Kato|first2=M.|last3=Kaneko|first3=Y.|last4=Onuma|first4=T.|volume=11|issue=4|pages=582–587|doi=10.1016/j.yebeh.2007.08.023|s2cid=45291893}}
Numbness or tingling (paresthesia){{Cite journal|title=Somatosensory auras in refractory temporal lobe epilepsy|journal=Epilepsia|year=2006|pmid=16417550|last1=Erickson|first1=J. C.|last2=Clapp|first2=L. E.|last3=Ford|first3=G.|last4=Jabbari|first4=B.|volume=47|issue=1|pages=202–206|doi=10.1111/j.1528-1167.2006.00388.x|s2cid=25666352|doi-access=free}}
Weakness on one side of the body (hemiparesis){{Citation|last1=Kumar|first1=Anil|title=Hemiplegic Migraine|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK513302/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=30020674|access-date=2022-01-11|last2=Samanta|first2=Debopam|last3=Emmady|first3=Prabhu D.|last4=Arora|first4=Rohan}}
Feelings of being separated from or floating above one's body (dissociation){{Cite web|date=2019-05-17|title=Dissociation and depersonalization: Causes, risk factors, and symptoms|url=https://www.medicalnewstoday.com/articles/262888|access-date=2022-01-11|website=www.medicalnewstoday.com|language=en}}
Feeling of overheating and sudden perspiration{{Cite web|title=Brain & Spine Foundation {{!}} Migraine|url=https://www.brainandspine.org.uk/our-publications/our-fact-sheets/migraine/|access-date=2022-01-11|language=en}}
Inability to speak (aphasia) or slurred speech{{Cite web|title=Recognizing Aphasia During a Migraine Attack|url=https://www.northsuffolkneurology.com/blog/recognizing-aphasia-during-a-migraine-attack-22559.html|access-date=2022-01-11|website=www.northsuffolkneurology.com|language=en-US}}

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Animated depictions

File:Scintillating scotoma - play.jpg|link=File:Scintillating zigzag scotoma.gif|Flickering animation of a scintillating scotoma, where the scintillations were of a zigzag pattern starting in the center of vision, surrounded by a somewhat larger scotoma area with distortion of shapes but otherwise melting into the background similarly to the physiological blind spot

File:Firefly aura.gif|A "firefly" aura. This variant has been described in cases of persistent aura without cerebral infarction.[https://books.google.com/books?id=YSoSECeCudIC&pg=PA258 Page 258] in: {{cite book|author=Britt Talley Daniel|title=Migraine|url=https://books.google.com/books?id=YSoSECeCudIC|year=2010|publisher=AuthorHouse|isbn=978-1-4490-6962-9}}

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