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Acephalic Migraine vs. TIA Stroke

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Posted 8/9/2007 10:14 PM (GMT -8)

My husband is a 35 year old male with no history of high blood pressure, migraines or headaches.  Four days ago while getting ready for work his right arm became numb and within 2 minutes his entire left side including his face was paralyzed.  He does not remember any visual disturbances and had no headache prior to the "attack".  From the first symptom to the peak of paralysis was minutes and all symptoms resolved within a half hour.  He was taken by ambulance to the ER - his brother, a paramedic, believed he may be having a stroke.  The ER performed a CT scan which came back negative, blood work and a Doppler carotid ultrasound which showed a little bit of plaque.  The ER diagnosed him with a TIA stroke and he was advised to take a "baby aspirin" (81mg) per day, magnesium daily and follow-up with an MD. 

We went and saw the doctor the ER recommended he follow-up with and he ordered some additional bloodwork to check his cholesterol levels and scheduled him for an ECHO.  This doctor is doubting the TIA diagnosis and suggested the migraine diagnosis instead.  During this doctor's visit my husband mentioned that every 2 or 3 months he has a half-moon shape cross over both eyes which takes approximately an hour to pass.  He has no headache when this happens.

History:

*5 years of age fractured skull in bicycle accident - tore his cochlea and is deaf in his right ear. 

* 24 years of age was in snowboard accident in which he spent 4 days in ICU for a concussion, whiplash and cervical sprain.  The left side of his head and neck hit a post at a high rate of speed.

* Paternal grandmother had a stroke at 42 years of age and spent 4 days in a coma.  She had no health problems prior to the stroke. 

For those with migraines who have suffered one-sided paralysis - how quickly did the paralysis get to it's peak?  Does anyone think his symptoms lean towards one diagnosis more than the other. At this point we aren't sure what we are dealing with and are hoping that some will have some advice/suggestions.  Thank you very much!

Posted 8/10/2007 12:58 PM (GMT -8)
Wow, this sounds almost exactly like what I went through.  I was actually at work and started noticing my right arm and hand going numb.  Before I knew it my complete right side of my body was paralyzed.  I accidently fell out of my chair, but was able to call for help.  The complete paralysis lasted for about ten minutes and then quickly went away.  At the ER they rushed me into the MRI to rule out an aneurysm or stroke.  After some other tests I ended up getting discharged with a diagnosis of a TIA.  I was also told to start taking 325mg of aspirin.  The next morning it happened again, so this time I was admitted.  I ended up having multiple MRIs/MRAs, EKG, EEG, ECG, and bloodwork.  Everything came back perfect.  I guess I should mention that at this time I was 29 years old, no high blood pressure, don't smoke, no diabetes, not overweight, very healthy and no risk factors.

It was finally suggested by my primary care that I might have an atypical migraine disorder.  I personally thought this was ludicrious because I have never had a migraine in my life.  But the more I started reading about them, the more I was convinced.  My PCP kept me on aspirin and put me on topamax.  She then referred me to a neurologist who specializes in migraines.  It was a couple of months after the first episode and by this time I was having them every day.  They would come on quickly, last for about ten minutes, then go away.  My right side would be weak afterwards for about an hour, but I could function.  Sometimes it would mess with my cognitive abilities for a while and I had trouble thinking clearly during the episodes and shortly after.

I documented all my episodes - when they happened, what time, what I was doing during them, how long they lasted, how I felt, and if there was anything strange or unusual during/before/after.  The neurologist examed all my tests, read my journal, and asked me a bunch of questions.  She diagnosed these as classic cases of hemiplegic migraines.  'hemi' for half and 'plegic' for paralysis.  She weaned me off the topamax and started me on verapamil, which is a calcium channel blocker used as a blood pressure medication.  She said that the paralysis is actually the migraine aura, but that it's no unusual to not get the headache itself.  She said that at some point in my life I may start to get the headache though.

I had one bad episode as I was leaving her office and that's the last time I've had the paralysis.  It took a while to adjust my medication to a level where the attacks were completely gone.  On the lowest dose that I tried I didn't experience paralysis, just a numbing in my arm and face.  I could still use it, but it was really heavy.  I discovered that caffeine was a trigger for me so I don't drink it.  Occasionally I do and I can actually feel myself having an episode, but my episodes now are very very mild numbing in my right cheek and very very mild weakness in my arm. I am completely functional through them and nobody could ever tell I was having one. 

It was such a weird experience (and scary) to go through and I'm still a little shocked at the ultimate diagnosis.  It's hard explaining to other people and even to other doctors about the condition I have because nobody's ever heard of it and they all look at me a little funny when I tell them all about it.  But that's ok. 

It's a hard thing to diagnose because you pretty much have to rule all the major things out (blood clots, stroke, heart problems, seizure disorder, etc.) before you can make an informed decision on it.  I have heard of people going years trying to find out what is wrong with them, so I think I'm lucky that it only took a few months for me. 

I hope that helps.  Sorry I wrote a novel, but I really wanted to tell you everything because your husband's experience sounds so similar to mine.  I hope he's doing well and that you get a diagnosis and some helpful medication soon.

Cat

By the way, I'm not sure I answered your question about how quickly the paralysis got to it's peak.  I could feel it starting - can't explain that feeling- and it took probably 1-2 minutes before full paralysis set in.  That normally lasted about ten minutes and then took about 1 minute to fade.  I would definitely look into hemiplegic migraine disorder.

Posted 8/10/2007 8:13 PM (GMT -8)

Cat - thank you so much for the reply.  Your history sounds so much like my husband's experience! I had him read your reply and he couldn't believe how similiar your experience was.  The reason I was questioning how quick the paralysis set in is because it seems like most of the research I've done says that the symptoms of a migraine producing paralysis progress gradually and do not come on suddenly.  After doing a ton of research I had been leaning towards a migraine condition but the explanations of the paralysis coming on gradually was throwing me and making me think that maybe the originally TIA diagnosis was correct after all.

Do you have visual disturbances when you aren't having a major episode?  My husband says that every 2 or 3 months he will have a half moon-like shape slowly cross over both eyes.  He says it takes about an hour for them to disappear completely and there is no headache along with it.  He had no visual disturbance that he can remember during his big episode on Monday.  Once in a great while he will complain of a slight headache and he said he would probably classify 4 or 5 headaches he's had over his lifetime as migraines.

So far all his tests have come back negative.  His blood test results for his Cholesterol were fine.  His Calcium,Ionized,Serum was slightly elevated and his Glucose was a little bit high.  You mentioned that caffeine is your trigger - what do you think about sugar being a trigger?  Interestingly on Monday morning when his attack happened his glucose was high even though he hadn't eaten in over 12 hours and also on Wednesday his repeat glucose test was high even though he had fasted for over 12 hours. 

My husband is about 40 pounds overweight but extremely active.  He doesn't drink or smoke but he has a horrible diet and on the Sunday before his episode we had dinner with his family and he ate ALOT of ice cream and had some cookies.  After dinner we went to the movies and he ate an entire box of candy and washed it down with a large icee-type drink.  The next morning is when he had his "attack".  So this is my theory...........that due to his diet and the head trauma he's had he has been teetering on the brink of a full-blown attack (instead of just having the visual disturbances every so often) and all the sugar he had the prior night finally pushed him over.  I also think that he may have an impaired fasting glucose level which could be fixed with his diet but is contributing to his condition.  Monday's attack put the fear of god in him and he's already lost 3 pounds.

He has a heart echo scheduled for Tuesday but now I wonder if we should just make an appointment with a neurologist instead so that he could get started on some medication??  Is verapamil the only medication that is helpful or are there many and you just need to figure out what works best for each person?  My husband also seems to be fatigued alot lately (although I'm sure that could be a by-product of his diet).  I also think as of late he forgets things and repeats things more often than normal.  He also seems to be at a loss finding words sometimes - it's almost like he checks out when he's talking and it takes him a few seconds to get back to what he is saying.  Does any of this sound familiar?

Thank you so very much for your reply to my post.  Any additional advice/suggestions would be greatly appreciated. We are glad to hear you are doing so well.  

Christine (& Mark!)

Posted 8/13/2007 7:04 AM (GMT -8)
Yes, that all sounds familiar. I have never had any visual disturbances, but I do remember my neurologist asking if I had experienced any, so I'm assuming it' common. I had a couple of aphasic episodes, where I wouldn't have the paralysis, but I definitely checked out. I remember being at work one time during one of these episodes and I was trying to type something. No matter how hard I tried I just couldn't hit the keys I wanted to. Then I tried to write down a number and I wrote the wrong one. I had a hard time communicating during this time also - I would have the words in my head, but different words would come up. During these episodes (there were only a handful) I *kind of* knew something was wrong, but I think I was so out of it that I didn't fully recognize that it was really wrong. I was just frustrated with myself for not being able to do whatever I was trying to do. It wasn't until after it passed that I realized what had happend. These have completely disappeared since I started the medicine.

I haven't really made a connection with sugar and episodes, but it's possible. My neurologist gave me a list of foods that people with migraines should avoid. It was so lengthy and included so many of the foods I like to eat I just ignore it! Chocolate is on there, as well as pizza. I just avoid caffeine and hope that the verapamil takes care of everything else.

I would definitely consider making an appointment with a neurologist, but I would try to find one that specializes in migraines if at all possible. The neurologist that saw me while I was in the hospital was not helpful at all. He scheduled the EEG to rule out a seizure disorder and at my follow-up visit he wanted me to be tested for carpal tunnel syndrome next..... I quickly went elsewhere. I ended up driving 2 hours to a major medical center (I'm in a semi-rural area) and it was well worth it.

Verapamil is a calcium-channel blocker and I know there are other types out there, but this is the one my neurologist recommended because she has such great results with it. If your husband does have this migraine disorder he needs to stay away from triptans. These are a specific class of medicine used to treat migraines - imitrex is the most common. Taking a triptan can increase or cause a stroke so they need to be avoided.

I am also fatigued a lot, but I don't know if it has anything to do with the condition or my lifestyle. I have two small kids and work full time at a demanding job. My fatigued has gotten so bad lately though that I have started to change my lifestyle to see if that will help. I began taking a multi-vitamin and have been exercising more regularly (or just at all!). It's only been a few weeks and I'm already starting to feel better. I think the rest is probably just me and doesn't have anything to do with the migraine disorder or the medicine I'm on.

Speaking of medicine, I will caution against topamax, which I was on for a few months. It helped some (not as well as the verapamil) but it really made my mind cloudy and also caused a lot of joint pain in my knees. In researching topamax I saw several times where people referred to it as dope-amax. However, I read where it did a lot of good for some people as well. That's one of the hard parts. First just getting a proper diagnosis, then finding the proper medication and dose.

Let me know if you have any more questions or if there's anything I can do to help. I hope the echo goes well tomorrow!

Cat
Posted 8/14/2007 1:00 PM (GMT -8)

Cat- thank you for the reply.  You have been a wealth of valuable information!!  Mark had the echo today and as long as that checks out ok we are going to obtain an MRI of his brain and then see a nuerologist who specializes in migraines.  Fortunately we live in a suburb of a major city so we have access to alot of good doctors.  Thanks again and I'll keep you informed.........

Christine

Posted 10/29/2007 9:53 PM (GMT -8)
Don't know if you'll make it back this way, but just in case and for the benefit of others that'll come this way...

The following are a list of other names this particular visual symptom are called by: 

scintillating scotoma

fortification spectrum

 Acephalic Migraine

telehopsias

 fortification figures

If your husband would do a little test he might find that the light arc that 'grows' within a visual field is actually only in his one eye.  The visual field of each eye overlaps into the other.  If he looks at an object, so that it fills 80%, with only one eye open and relatively centered in that eye's visual field (does not have to have a migraine aura in progress) now...not turning the head at all, close that eye and open the other.  You aught to be able to see that object entirely, with the opposite eye. So that even when the eyes are closed the 'trapped' light in the one eye is still filling a shared visual field.  The brain still perceives the whole visual field even in the deepest part of the eyeS.  There's a cone in each eye, and the one tip side registers the same data field as the mouth of the cone, just makes it smaller on the inner tip end.  Probably to fit it all into our little brains.  So you have a growing little light on the inner most part of the one eye while the brain registers a shared field from both eyes (much of it overlapping).  You won't find a double vision of the exact same shape in both eyes, from what I could gather from people's reports, if it's in the right eye,it'll be strongest on the right side of the eye (3:00) if it's in the left you'll see it strongest at 9:00.  Some have a full circle or almost, reportedly in one eye.

From what I can make of mine, the light that is normally received and organized by the optic nerves regarding depth of brightness/darkness and contrast (as well as color etc) is for some reason condensing, refracting or absorbing within some kind of 'crystal' that burns out after a few minutes.Except mine alway grow from approximately if not the exact same place.  It certainly arcs the same way and in the same direction. Even the same as last year.  Counterclockwise from 4: to 11: (approximates at their highest intensity)  However,their intensity/magnification isn't always the same.  

Anyway, the overlapping of the visual fields is why it appears to be in both eyes even when our eyes are shut. (That's why I mentioned absorbed, as obviously, something is retaining the light that comes in through normal optic functions but that in striking that particular area, I'd say deep within the eye and just a very small nick, but as it's 'light' grows it is sufficient to start to overwhelm the visual field of the affected eye near the 'gate of sight' 'center of the eye' whatever.... Maybe it's a light censor getting overexposed.  As though a filter grew too thin.

I'm sighting my observations in the hope that someone with a better understanding of optics might be able to use this.  Supposing this is NOT at all related to Transient Ischemic Attacks (TIAs) and it's been ruled out.

So if you can confirm any descriptions I've given I'm sure it would help.

I do not get headaches with mine, and I seldom have ever have had them. I really don't like using the word migraine even if the cause is from the same problem.  It certainly is a different symptom from what is commonly known as a migraine being a headache.   There's a little eye ball pain, but that's only occasionally, sometimes it's photophobic type of pain(at it's max-too much light) Maybe it's all photophobic pain just lingering in a duller level of pain. 

My aura's started last summer.  Only one every now and then...nothing all winter and spring, and now they're back.  Either sunlight or computer moniter seems to get it started, even if only in from the edge of eye field.  It seems much brighter if bright light is 'feeding' it. Not half as bright and colorful when the eyes are closed.  My colors don't move as I've heard some report but they do bend into the edge of the triangles (cross section of a cell?)  I've had 4 or 5 in that past 2 weeks, which is really unusual and has me a little tense now.   I'm one of those people that have to be laid out by something before I'll own up to it to any doctor.  My aura's start small as all do...and the arc grows to fill a large portion of the field.  Mine have definate triangles with all 3 sides, (no open bottom-thus other's zigzag description)they are arranged side by side, the next one flipped in the opposite direction and joined to another triangle again flipped to be the opposite direction.  So there's a zigzag within but definately mine has edges bordering the zigzag,  similiar to a path with a zigzag drawn lengthwise in between. An analogy -  A slightly spiral (arc) staircase made with triangles(bent/distorted/reflected light). Generally all triangles are the same size, but do taper off to be smaller, but is never so magnified as the shapes in the first 4/5ths or so grow to be.    Now there's a mind teaser for somebody. 

Anyway, here's some links I think would be of help, though I lost one (thought I saved it)  There's lots out there.  Though I would search out:

scintillating scotoma pictures 

http://imigraine.net/migraine/withaura.html

http://www.moondragon.org/health/disorders/eyesscotoma.html

  If you think it's  a particular food, eat it again and see if it is the instigator.  However, a food or edible/drinkable substance might still be the instigator when combined with onset of other physiological problems/symptoms such as high blood pressure with salt etc. I don't think it'd be easy to track down this way unless somebody out there does some trials with a few suspects in mind.

Just when I thought my long wind had come to it's end... Relevent to note:  I do have a tiny blind spot (not the usual one) which is actually a relatively dull light spot in the very middle of the affected eye.  It is a result of looking at an solar eclipse when younger...no wise guys around those days.  It only blocks out a letter or 2 when reading but it is a white spot over where the letters should be.  Hard to read with just the one eye if I had to. Anyway, might explain why I have borders on my zigzags. Who know...

There are other details, but what is crucial has been said without perhaps stepping into symptoms from other problems I have or am expecting to have with currently known diseases or medication usage.  

 Hope I've been of help, Sandra

Posted 10/30/2007 5:19 AM (GMT -8)
Wow!  Sandra - thank you very much for the information.  I printed it out and will go over with my husband this evening.  He's about due for his aura as it has been a few months since he's had an episode so he'll be able to try the "test" you mentioned.  Thanks again for the information!  Christine

Posted 1/28/2009 10:32 AM (GMT -8)
OMG, I'm so scared...  I did not have my MRI yet so they are not 100% sure if this is the Acephalgic Migrane yet...  they think it is...  I don't know how I will be able to function never knowing when it is going to strike, and even if it's not a TIA how will I ever know down the road if I have an episode and it is a TIA or stroke, the symptoms are identical.  I need somebody to help me because it's like I'm sitting here waiting for an episode.  I'm very sad....
Posted 1/29/2009 6:30 AM (GMT -8)

Barbara,

I posted orginally awhile back and fortunately my husband has not had another episode.  I don't know what your history is but don't panic!  My suggestion would be to search around this site and/or the web for people who are actively dealing with this issue and they could help you with any questions you have.  By thinking positively and being pro-active you will feel much better!  :)

Christine 

Posted 1/29/2009 9:04 AM (GMT -8)
Thank you for your reply, Christine. I go a week from tomorrow for my MRI so at least that will be able to show if what I had on 4 occasions was the TIA. I will never relax with this.... how will I ever know if I am having a real stroke or this acephalic episode, I will never know, just sit and hope it's the episode. Anyway, thanks for the quick reply.

Barbara
Posted 2/28/2011 4:09 AM (GMT -8)
I've had these things for 14 yrs now, & this is the first time i've ever gotten involved w/ a forum!

my story is similar, but for sure more severe. there must be a genetic component, b/c my mom (i'm 35) has been able to guide me through it since she had the same thing. she hasn't had one (i think) since menopause, so we believe there's a hormone component.

lots of things to say that seem like might help others, so here goes!

i had my 1st one after being on the birth control pill for just under a year. sounds just like the above stories: going numb on 1 side, but i completely could not communicate, talk, write, my vision went weird, hearing in & out-i woke up in the hospital cuz i blacked out completely. i literally thought i had gone crazy. the ER doc told me (i was only 21 & very naive!) it was a TIA brought on by the BC pill & to never go on it again, that some women couldn't handle the hormones.
we moved from CO (high altitude & 300 days of sun) to Chicago (not much sun & sea level), & for 8-9 yrs, i didn't have a single one. as soon as we moved back to CO, I had maybe 3 within a couple months, & a few more within our 3 yrs there.

mine were so bad a couple put me in the ER b/c i couldn't function & people around me didn't know what to do!
i also had never had headaches, but boy did i get a rude awakening!
mine slowly (maybe several minutes) went from tingly numbing face, hands, arms (usually 1 side, sometimes both) to worse & worse confusion, always losing my ability to communicate, read, write-anything. my husband has gotten used to it, keeping my kids away b/c i get really confused easily, then i cry b/c it's scary.
anyway, if i took a Maxalt right away, it would keep the headache at bay, i'd need a solid 12 hrs to sleep, & i'd be pretty normal the next day-maybe just a bit tired.

they varied in severity. then we moved 2008 to China (sea level, completely different climate). i didn't have one the 1st year; i had a mild one the 2nd year, & i just had maybe my worst ever 2 wks ago. i was convinced it was the altitude, sun, maybe dehydration. but not so apparently!
here's a theory: 3 mos. ago I had a D+C for a year's worth of irregular bleeding. it could very well be the whole hormone theory wreaking havoc on my body. who knows.
but this aura was so bad that it made me more depressed than ever (thinking thoughts like "what if this is related to alzheimers & dementia like my grama? what if i lose my mental acuity more & more from this?" i've heard we suffer slight brain damage from these!). in the last couple years i have just felt like my mind is slipping, i'm not as quick as i used to be-not getting younger, right:)
importantly, the Maxalt simply didn't work this time. i had maybe the worst headache EVER-i was writhing in pain. i have the utmost sympathy now for sufferers. i was also confused from the moment i woke 7am for maybe 8-10hrs, but still slow for days after. yes, i need help. i don't have the medical care till summer, but will for sure get it!
i am now working part time, so it's not necessarily stress, although i do have 1.5 special needs kids (1 pretty needy, the other not as much)
i just have to acknowledge that at least i'm at peace about it b/c of strong faith. God will take care of me & lead me to the right doctors & medication & won't give me more than i can handle. look to Him, the Great Physician...
-fellow sufferer
Posted 2/28/2011 8:31 PM (GMT -8)
Hi Whatuask,

Sorry to hear you're having a rough run of it recently. That sounds tough. I'm going to keep this short as my brain is foggy (getting used to a new med).

I would strongly recommend getting an appointment with a good headache specialist. It could be so many things and they are going to want to run some tests. That said, it does sound a lot like either familial hemiplegic migraine or basilar migraine. Look them up and see what you think (only you know your body/headaches).

With migraines in general, hormones can definitely play a huge part. And yes, after menopause many women find their migraines diminish or disappear altogether. The altitude component to your migraines is very interesting. Some people can break their headaches with oxygen. If you end up in the ER again for migraines, ask the doctor what they think about trying a little O2 to try and break the headache.


I hope you find relief!

Post Edited (EvilFluorescents) : 2/28/2011 9:55:33 PM (GMT-7)

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