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Crescendo transient Aura attacks: a transient ischemic attack mimic caused by focal subarachnoid hemorrhage

Aaron Izenberg1, Richard I Aviv, Bart M Demaerschalk

  • 1Dr Thomas and Harriet Black Acute TIA Unit and Regional Stroke Prevention Clinic, Division of Neurology and Brain Sciences Program, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Toronto, Ontario Canada.

Stroke
|November 7, 2009
PubMed
Abstract

Insights

Focal subarachnoid hemorrhage can mimic transient ischemic attacks in elderly patients, presenting as repetitive migraine auras. Early MRI detection is crucial to avoid misdiagnosis and ensure appropriate management.

Area of Science:

  • Neurology
  • Neuroimaging
  • Vascular Neurology

Background:

  • Transient ischemic attack (TIA) diagnosis is challenging due to numerous mimics.
  • Distinguishing TIAs from other neurological events is critical for appropriate patient management.

Observation:

  • A case series of four elderly patients presented with stereotyped somatosensory migraine auras.
  • These patients were initially suspected of having crescendo transient ischemic attacks.
  • Neuroimaging revealed focal subarachnoid hemorrhage in the contralateral hemisphere, conforming to a cortical sulcus.

Findings:

  • The study identified a distinct mimic of transient ischemic attack: focal subarachnoid hemorrhage.
  • Migraine aura symptoms were postulated to result from cortical spreading depression triggered by subarachnoid blood.
  • This presentation may indicate cerebral amyloid angiopathy, even without typical microbleeds or cognitive impairment.

Implications:

  • Focal subarachnoid hemorrhage can manifest as recurrent migraine auras, mimicking transient ischemic attacks.
  • Misdiagnosis can lead to inappropriate treatment of suspected ischemic events.
  • Elderly patients with new, unexplained migraine auras require MRI investigation to rule out focal subarachnoid hemorrhage.

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