Aura (symptom)

# Overview
Aura is the perceptual disturbance experienced by some migraine sufferers before a migraine headache, and the telltale sensation experienced by some people with epilepsy before a seizure. It often manifests as the perception of a strange light or an unpleasant smell.
An aura does not necessitate the onset of either a migraine or a seizure and not everyone who suffers from migraines or seizures will experience auras. Though auras tend to be an unpleasant and irritating sensation, they can be beneficial.  Most injuries from seizures occur when there is no warning. Auras allow epileptics time to prevent injury to themselves. The time between the appearance of the aura and the onset of a migraine or seizure can be anything from a few seconds up to an hour. Most people who have auras have the same type of aura every time.

# Classification
- Auras can take on the following forms:
Auditory
Sensory such as olfactory (smell)
Visual
Olfactory auras can also be described as deja vu or dreamlike sensations
- Auditory
- Sensory such as olfactory (smell)
- Visual
- Olfactory auras can also be described as deja vu or dreamlike sensations
- Can possibly be attributed to the area of the brain involved

# Causes by Organ System

# Causes in Alphabetical Order
- Absence seizures
- Color blindness
- Complex partial seizure
- Epilepsy
- Familial hemiplegic migraine
- Focal seizures
- Gluten-sensitive enteropathy associated conditions
- Migraine
- Partial seizure
- Physiologic nonepileptic seizures
- Pituitary adenoma
- Simple partial seizure
- Temporal lobe epilepsy
- Tonic-clonic seizure

# History and Symptoms
- Aura (type)
- Family history
- Associated activities
- Triggers
- Symptoms postaura
- Loss of consciousness
- Prior trauma

# Physical Examination
- Complete head and neck exam
- Complete neurologic exam

# Laboratory Findings
- Complete blood count (CBC)
- Calcium
- Magnesium
- Glucose
- Blood urea nitrogen (BUN) / creatinine

## Electrolyte and Biomarker Studies
- Electrolytes

## MRI and CT
- CT for trauma of physiologic seizure
- MRI rules out cerebral pathology

## Other Imaging Findings
- Electroencephalogram (EEG) for seizure activity

## Other Diagnostic Studies
- Toxicology screen

# Treatment
- Avoidance of triggers (migraines)
- Stabilize patients with status epilepticus

# Pharmacotherapy

## Acute Pharmacotherapies
- NSAIDs (nonsteriodal anti-inflammatory drugs) (migraines)
- 5-HT1 agonists (migraines)
- Acetaminophen (migraines)
- IV benzodiazepines (epilepsy)
- Antiepileptics (epilepsy)An aura sensation can include:
- Visual Changes.
Bright lights.
Zigzag lines.
Distortions in the size or shape of object.
scintillating scotoma
Shimmering, pulsating patches, often curved.
Tunnel Visionscotoma
Blind or dark spots in the field of vision.
Curtain like effect over one eye.
Slowly spreading spots.
Kaleidescope effects on visual field
Total temporary monocular (in one eye) blindness. (in retinal migraine)
- Bright lights.
- Zigzag lines.
- Distortions in the size or shape of object.
- scintillating scotoma
Shimmering, pulsating patches, often curved.
Tunnel Visionscotoma
Blind or dark spots in the field of vision.
Curtain like effect over one eye.
Slowly spreading spots.
- Shimmering, pulsating patches, often curved.
- Tunnel Visionscotoma
- Blind or dark spots in the field of vision.
- Curtain like effect over one eye.
- Slowly spreading spots.
- Kaleidescope effects on visual field
- Total temporary monocular (in one eye) blindness. (in retinal migraine)
- Auditory changes
Hearing voices or sounds that don't exist: true auditory hallucinations.
Modification of voices or sounds in the environment: buzzing, tremolo, amplitude modulation or other modulations.- Strange smells (olfactory hallucinations).
- Hearing voices or sounds that don't exist: true auditory hallucinations.
- Modification of voices or sounds in the environment: buzzing, tremolo, amplitude modulation or other modulations.- Strange smells (olfactory hallucinations).
- Feelings of numbness or tingling on one side of the face or body.
- Feeling separated from one's body.
- Feeling as if your limbs are moving independently from your body.
- Anxiety or fear.
- Nausea.
- Weakness, unsteadiness.
- Being unable to understand or comprehend spoken words during and after the aura.
- Being unable to speak properly, despite your brain grasping what you're trying to verbalize.  (Aphasia)
- Feeling of power or sense of euphoria (this symptom has been associated with discontinuation of seizure treatments - the sufferer may enjoy the experience and think it worth the seizure or migraine that follows)The specific type of sensation associated with an aura can potentially be used in an attempt to localize the focus of a seizure. Auras share similar symptoms with strokes, but onset is more gradual with auras. 

# Related Chapters
- Hallucination
- Paresthesia
- Synesthesia
- Simple partial seizure
- Complex partial seizure