This study explores the possibility that migraine aura can be the presenting feature of embolic stroke.

Study design

The prospective analysis included 14 patients who presented with symptoms consistent with a clinical diagnosis of migraine aura, but subsequently showed evidence of an acute infarction on MRI.

Outcomes

In all patients, migraine aura symptoms were not directly attributable to vascular lesions seen on MRI.

Half of the cohort was classified as having an embolic stroke of undetermined source. Of these, a patent foramen ovale was identified in 4 of 5 who underwent a transesophageal echocardiogram, with large right-to-left shunt demonstrated in 3.

Limitations

This study was limited by a small patient population.

Clinical significance

The results from this cohort suggest that migraine aura can be the presenting feature of acute ischemic stroke, leading the authors to hypothesize that local ischemia triggers a widely migrating cortical wave of spreading depolarization.