Persistent aura without infarction

Persistent Aura Without Infarction (PAWOI) is a rare neurological condition characterized by the persistence of aura symptoms for weeks, months, or even years without evidence of cerebral infarction (stroke) on imaging. Auras are perceptual disturbances that commonly precede or accompany migraine headaches but can also occur in isolation. Symptoms of aura can include visual disturbances, such as seeing flashes of light, zigzag patterns, or experiencing blind spots; sensory changes, like tingling or numbness in the face or extremities; or speech and language difficulties.

Symptoms and Diagnosis

The hallmark of PAWOI is the prolonged duration of aura symptoms beyond the typical timeframe associated with a migraine aura, which usually lasts less than 60 minutes. The persistent nature of these symptoms without the occurrence of a stroke distinguishes PAWOI from other neurological conditions. Diagnosis involves a thorough medical history, neurological examination, and often imaging studies such as MRI to rule out other causes of the symptoms, including stroke or transient ischemic attack (TIA). It is crucial to differentiate PAWOI from migraine with aura and other conditions that can mimic its symptoms, such as epilepsy or multiple sclerosis.

Causes

The exact cause of PAWOI is not well understood, but it is thought to involve abnormal electrical activity in the brain that extends beyond the typical duration of a migraine aura. This condition is considered rare, and research into its pathophysiology is ongoing. Factors that may contribute to the development of PAWOI include genetic predisposition, hormonal changes, and environmental triggers similar to those that provoke migraines with aura.

Treatment

Treatment of PAWOI focuses on symptom management and prevention of future aura episodes. Options may include medications commonly used to prevent migraines, such as beta-blockers, anticonvulsants, and calcium channel blockers. In some cases, antidepressants or medications used to treat epilepsy may also be effective. Non-pharmacological approaches, such as stress management, cognitive-behavioral therapy (CBT), and lifestyle modifications, can also be beneficial. Due to the rarity of the condition and the variability in symptoms and response to treatment, management is often tailored to the individual.

Prognosis

The prognosis for individuals with PAWOI varies. Some may experience a reduction in symptoms over time, while others may have persistent symptoms that significantly impact their quality of life. Ongoing research is needed to better understand this condition and develop more effective treatments.

See Also

• Migraine
• Aura (symptom)
• Cerebral infarction
• Epilepsy
• Multiple sclerosis

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