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On a Saturday morning, right after having a cup of coffee, the engineer Alexandre Godoiaged 58, thought he would start the weekend with one more severe migraine attack triggered by caffeine. Godoi who did not have any other previous illness and suffers from chronic migraine with aura years ago, he noticed his vision begin to blur (a classic sign of the aura) and felt the pain in his head.
As usual, he decided to take a painkiller and lie down in a dark room to wait for the crisis to pass. Over time the headache subsided, but the peripheral vision remained poor and persisted for over 24 hours.
Worried about the permanent alteration of the visual field, the engineer went to the emergency room the next day and discovered that he had not had a severe migraine attack, but a AVC (stroke), whose only symptom was the loss of the visual field, which ended up being confused with the aura.
“The right side of my vision blurred, like a finger smudge on a photograph. I could still see perfectly when I looked straight ahead, but my peripheral vision on the right side was impaired. As I didn’t have any other motor or physical symptoms, which are the most common signs, I never imagined it would be a stroke. I thought it was a migraine with prolonged aura”, says Godoi.
Migraines: what are your main risks?
Ter migraine with aura (or migraine with aura, in technical language) increases the risk of suffering a stroke by three times. It was even recognized as a risk factor for such events in studies reviewed at least ten years ago.
According to the neurologist Polyana Pizzafrom Hospital Israelita Albert Einstein, stroke can be ischemic (when blood circulation is blocked in a certain region of the brain) or hemorrhagic (when there is a rupture of a cerebral vessel).
The first exam to determine what is happening is the computed tomography, being the fastest, differentiating ischemic from hemorrhagic stroke – which is essential to determine the conduct of treatment. Then, depending on the need, an MRI is performed to confirm or not the stroke.
In the case of an ischemic stroke, if the patient seeks care within the first four and a half hours after the onset of symptoms, it is possible to reverse the condition through an intravenous procedure. Within 24 hours after symptoms, depending on the case, it is possible to perform a mechanical thrombectomy (catheterization procedure to remove the clot).
Therefore, it is so important that patients know how to identify the signs that something is wrong, because the sooner they seek help, the less chance of sequelae remaining.
How to identify signs of stroke risk
A stroke is not always accompanied by physical or motor symptoms (such as paralysis on one side of the face, drooping mouth, difficulty speaking, loss of coordination). Everything will depend on the territory affected — in the case of Godoi, the affected region was the occipital region, responsible for the neurological interpretation of the visual field, hence the loss of peripheral vision.
“The territory most commonly affected is the one irrigated by the middle cerebral artery, responsible for the irrigation of the motor part. Therefore, people are more used to the symptoms related to movements”, explains Piza.
One of the ways to turn on the warning signal is to learn to identify the duration of the aura episode. In general, explains Polyana, the classic aura is characterized by temporary disorders that include visual changes, blurred vision with the presence of sparkles, lights and spots that can move in the patient’s visual field.
It usually precedes the headache and lasts from five to 60 minutes. — rarely goes beyond that. The aura disappears when the pain ceases and, with it, add the visual disturbances.
“If the patient arrives at an office or emergency room reporting an acute visual alteration, it is necessary to investigate and he/she must necessarily be submitted to an image exam for the correct diagnosis”, emphasizes the neurologist.
“Any acute symptom in neurology has a vascular problem as its main cause, even if it is not persistent”, he said. In Godoi’s case, what he suffered was not a migraine with aura, but a stroke — the duration of the alleged aura was the warning sign.
Stroke is the leading cause of morbidity and the second leading cause of death worldwide. According to the expert at Einstein, one out of four patients who suffer from migraines has an episode with aura.
Piza points out that the best way to prevent is to follow up with a neurologist for a prophylactic treatment, which prevents the occurrence of the migraine crisis. “There are different classes of medications indicated for different patient profiles”, concludes the specialist.