Are you sure it's safe to let Mom out of the house...?

A rare document of an acute speech problem (aphasia) during a migraine attack could recently be seen on air. A still hardly known migraine symptom that deserves more attention—and definitely no need to call an exorcist.

About a week ago, I read in the New York Times the headline "Did a Reporter Have a Stroke on TV?". I—as more than a million others—became a video witness to what happened to Serene Brandson.

In the article, I read about the first suspicion, which turned out to be wrong.

“What a terrifying event,” said Dr. Daniel Labovitz, assistant professor of neurology at Einstein School of Medicine and attending stroke neurologist at Montefiore Medical Center in the Bronx. “I very strongly suspect this was a stroke or transient ischemic attack.”

"Someone call an exorcist!" was one of the jokes in the blogosphere, though this post is gone now. Well, I immediately thought (and twittered) that this could be a migraine aura, that is, a neurological symptom that occurs before the migraine headache. But it takes a few days to investigate and write an informative blog post.

Why migraine? Just because I know about the chances. It is far more likely to have a migraine with aura than a stroke. On air, at home, anywhere. And indeed it was a migraine attack, as we know now.

Migraine or stroke

So how can I decide whether it is a migraine aura or a stroke? Well, I cannot. Only a physician who sees the patient can. (And you should see one, if this or similar speech problems happen to you. I repeat. You must see a medical doctor, if you experienced similar speech problems—even if only for a few minutes and then everything is back to normal. I am a physicist by the way. Do you really want one of those to diagnose you? Or a website?)

Having said this, there is a rule of thumb, which, however, might trick you. In fact, it might have tricked the neurologist who was cited in the NYT. Neurological symptoms caused by a stroke (or a transient ischemic attack) have usually a rather sudden onset. We are talking about seconds. In contrast, migraine aura symptoms progressively develop. Often only after one minute or even later you will realize that they are there. In the video, the onset was seemingly very sudden.

Now read the next example. We collected this, among various other examples of aphasia in migraine, on a web page of the Migraine Aura Foundation. The original is from a Newsgroup back in 1998:

"I KNOW I have some form of aphasia, too, before the onset of the migraine. It's very irritating for people to have to try and complete my sentences for me. Example: 'Erica, could you make sure the milk gets put back into the....the....oh, it's a simple word, you know what I mean....(exasperated sounds)' 'Mom, do you mean 'refrigerator'?' 'YES!, that's the word I was searching for!' 'Daaaaad, mom's acting really weird again!'"
(Anne Buede, Newsgroups: alt.support.headaches.migraine, Subject: anyone "manic" before a migraine?, February 17, 1998)

A few hours later the some day this examples continues: 

"I was just reminded by someone who loves me very much: P that it gets even stranger than I just described:
Me: 'Honey, could you....um....you know, (here I begin to make lifting motions with my arms), could you do that thing....that movement where you ...do something....to the milk... so that it gets into the refrigerator?'
Erica: 'Mom , do you want me to 'pick up' the milk?'
Me: 'Yes'!
Erica: 'Daaaaad! Are you sure it's safe to let Mom out of the house...?'"
(Anne Buede, Newsgroups: alt.support.headaches.migraine, Subject: anyone "manic" before a migraine?, February 17, 1998)

A fine sense of humor to start with. But think twice about this. Does this speech problem have a sudden onset?

Before even looking for words like 'refrigerator' or 'pick up' (or all the other words that are also potentially missing during this very moment), you might not have a chance to realize that something is wrong. How will you know the time of onset?

Aphasia can be very complex. Missing words and talking gibberish is only a fraction of the spectrum of speech and language symptoms. Determining the onset of these symptoms is by far not easy. The onset is much more subtle in comparison to, for example, the onset of visual field defects, which are more frequent and also much better know in migraine.

To end this, here is the last example. Again speech symptoms that happened while being on air.

In this case, the diagnoses is even more complicated, as  Sarah Carlson suffers from epilepsy and had a brain tumor removed four months before this incident. Again, it might also be caused by a migraine with aura as there is a co-morbidity between the two conditions. Just from the video, no one can tell.

So is it safe?

While it is safe to "let mom out of the house", in particular when she knows these symptoms and had seen a doctor before, it can be dangerous ignoring such symptoms when they happen the first time.

 

 

Link

A short URL:

http://goo.gl/Ohdrz