TIA and Stroke Vs. Migraine with Aura

TIA and Stroke VS. Migraine with Aura symptoms

The arteries that supply blood to the brain are as follows: left and right carotid, supplying the front of the brain and the left and right vertebral, supplying the back of the brain.  There is a direct relationship between the artery, the part of the brain it supplies, and function.  For instance, the artery that supplies the part of the brain which controls right hand function is on the left side of the brain.  This artery is the left middle cerebral artery, one of the branches of the carotid artery in the brain.  A temporary (like with a TIA) or a permanent (like with a stroke) disturbance of arterial blood supply will cause trouble using the part of the body that is involved.  For instance, with the example discussed above, a stroke involving the left middle cerebral artery will cause trouble talking and weakness of the right face, arm, and leg.  If the brain is deprived of blood for over 4 minutes then damage may occur.

Understanding these anatomical and physiological relationships, I can now discuss TIA and Stroke Symptoms.  TIA means Transient Ischemic Attack and it refers to a brief, usually 30 minute, disturbance of neurologic function caused by blockage of blood supply to the brain.  Most TIAs last 30 minutes or less, but the full definition says they may last as long as 24 hours.  TIAs come from focal arterial blood supply disruption to a localized area of the brain. 

The symptoms of a TIA may be:

1. Aphasia--sudden onset of trouble talking or naming with garbled or blocked speech.

2.  Sudden loss of function of a limb, such as the right arm and leg, or perhaps one arm or leg alone.  The motor function loss is not usually in the distribution of a cranial or peripheral nerve, like trouble bring the foot up with fibular neuropathy of the leg.  It’s just that the whole leg or foot is weak.

3.  Sudden tingling or numbness in the face, arm or leg, usually on one side, sometimes on both sides.  On the body the symptom usually stays in one place and doesn’t move.  The symptom also is not usually in the distribution of a cranial or peripheral nerve, like numbness in the thumb, forefinger, and middle finger with median nerve involvement with carpal tunnel syndrome.  It’s usually the whole arm, or the hand and arm that’s numb.

4.  Sudden loss of vision in one eye, usually the whole eye or the upper or lower part, like a curtain coming down or going up.  The visual loss is sudden and usually doesn’t move across the visual field but stays in one place.

5.  Sudden onset of vertigo, or a spinning or whirling feeling.

Symptoms which are not TIA are: fainting, loss of memory, blurred vision, jerking-like with a seizure, dizziness, sweating, chest pain, off-balance, tripping or falling down.

Migraine with aura symptoms can include seeing objects in the visual field which usually have a crescent or moon shape and which may flash, be multicolored, and move.  TIA or stroke visual symptoms are negative and the patient can’t see part of their usual visual field, like a curtain coming down.  Migraine with aura symptoms may move while TIA or stroke symptoms don’t.  Migraine symptoms come on slowly while stroke or TIA symptoms symptoms come on suddenly and don’t move.  Migraine with aura symptoms affecting sensation or speech are usually on the opposite side of the head.  So, with migraine with aura the symptoms would be headache on the left side of the head and numbness of the right hand that moves to the cheek, or trouble talking, in a right handed left brain dominant person.  Migraine with aura may cause symptoms of numbness or a tingling feeling which may begin in one finger, like the pinkie and stay there for several minutes and then spread to the other fingers slowly and sequentially.  So, the pinkie is numb and then it clears and the ring finger is numb and it clears up, and so on, sequentially involving all fingers and lasting 5-10 minutes.  Then, the numbness is noted in the lips and tongue on the same side.

Weakness with migraine with aura is rare and is a symptom to be differentiated from sensory symptoms of feeling “numb, or tingling." ..The patient with migraine rarely means “paralysis” or complete muscular immobility but that can happen with a stroke.  Hemiplegic migraine affects boys while teens and may be found in their father.  Hemiplegic migraine is very rare.

Migraine patients may have temporary trouble talking and this may be very similar to the speech loss of a TIA or stroke patient.  Stroke patients about 10 percent of the time may have headache so having a headache doesn’t make the diagnosis migraine.  Stroke altered speaking may last weeks, months, half a year, or forever, but TIA and Migraine involvement usually clears in 20-30 minutes.  TIA language trouble usually doesn't come with headache, while the migraine patient with language trouble usually has headache, a visual aura, and numbness that moves across the fingers and hand to the face. Aphasia is the name for forming speech and naming things.  

The rule is migraine cerebral symptoms are temporary but move.  If the visual symptoms move, it’s likely to be migraine.

Stroke symptoms don’t move across the body;  they usually stay put.  If they go away in 30 minutes and the MRI scan and neurologic exam are normal, likely the patient had a TIA.

Also if the patient has never had significant headache and he experiences an unusually severe sudden headache (see Thunderclap Headache in Miscelanea Migrainica Category), it would be concerning for a stroke from either a ruptured aneurysm causing subarachnoid hemorrhage or a cerebral hemorrhage.  Sudden headache with loss of consciousness, a seizure, vomiting, development of limb weakness or numbness, or loss of vision or double vision would favor a stroke mechanism.  However, if the patient is a chronic migraineur with a long history of one-sided, throbbing headache, sensitivity to light or sound, or intense level 7-10 on a pain scale of 1-10, then migraine may be more likely.  Both patient types need to report to the ER immediately and be seen by a doctor and scanned.