Migraine with aura |
▸ An aura is a transient subjective feeling of unusual visual symptoms, abnormal sensations (numbness or ‘pins and needles’) or speech disturbance that typically precedes onset of headache ▸ Aura symptoms are described in up to one-third of childhood migraine ▸ Onset is gradual over 5–20 min (as opposed to seizures) and lasts <60 min ▸ Abrupt onset of visual aura may indicate occipital lobe epilepsy
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Typical aura without headache (acephalgic migraine) |
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Hemiplegic migraine |
▸ Either familial or sporadic ▸ Typical presentation is with stroke-like hemiparesis with a migrainous-type headache ▸ Clinically evident weakness must be demonstrated ▸ May be confused with Todd's (postictal) paresis
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Acute confusional migraine |
▸ Attack is marked with abrupt onset of agitation, disorientation and behavioural changes ▸ Confusion lasts from minutes to hours ▸ There may be no recollection of the event and the associated headache ▸ A diagnosis of exclusion
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‘Alice in Wonderland’ syndrome |
▸ A form of migraine with atypical visual aura ▸ Abnormal visual illusions with spatial distortions ▸ The differential diagnosis includes occipital lobe epilepsies
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Retinal migraine |
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Basilar-type migraine |
▸ Symptoms (and signs) of brainstem or posterior fossa involvement ▸ Attacks of dizziness, vertigo, ataxia, dysarthria and diplopia for minutes or up to an hour followed by the headache phase ▸ May be associated with decreased level of consciousness ▸ The combination of the above features may be confused with complex focal seizures
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