Is It Migraine Aura in the Elderly or Transient Ischaemic Attack?

Abstract

A 65-year-old right-handed retired dentist presented to the outpatient neurology clinic after experiencing five episodes of transient focal neurological symptoms in a 1-year period. In fact, he had experienced similar episodes at a lower frequency in the past few years. A single episode was most often characterized by isolated visual symptoms; however, on some occasions these were followed by sensory symptoms and/or language impairment. There were nerve motor symptoms. The visual disturbance is described as a ‘moonshaped grey-brown spot’ which is growing over time and evolving into its maximum size over about 20 min on average, followed by a rather fast and complete resolution of the symptoms. He had evaluated his vision with both eyes separately and noticed the symptoms were binocular and present in either the right or left visual hemifield. Sensory symptoms and mild language impairment had on a few occasions followed the visual disturbance and were described as progressive tingling in one arm starting in the hand and moving up the forearm and word finding difficulties; a detailed description could not be given. These focal neurological symptoms were followed by a mild, generalized, featureless headache which he rated 3–4/10 on a verbal rating scale. These headaches tended to respond well to ibuprofen and disappear within a few hours after onset. These attacks could on occasion be triggered by bright light but most attacks came on spontaneously. His past medical history was remarkable for arterial hypertension, successfully treated with perindopril, and mild reflux esophagitis.