Persistent aura without infarction.
Current opinion in neurology – June 01, 2025
Source: PubMed
Summary
Some migraine auras can persist for days or weeks without causing brain damage, presenting a unique medical challenge. When cortical spreading depression occurs without resolving naturally, it creates continuous visual disturbances and other neurological symptoms. Several medications show promise in treating this condition, including acetazolamide, valproic acid, and zonisamide. Ketamine and furosemide have also demonstrated effectiveness, particularly when combined with cortisone therapy.
Abstract
The scope of this review is to discuss persistent aura without infarction, a rare, highly disabling, yet apparently benign clinical condition, straddling neurology, neuro-ophthalmology, and psychiatry, whose differential diagnosis is essential for an appropriate therapeutic approach and to avoid clinical complications. Here we attempt to report on the available literature, trying to present a summary, despite the scarcity of available literature. Persistent aura without infarction is a diagnostic challenge, likely caused by cortical spreading depression and vasoconstriction, whose clinical features are not always easy to pigeonhole into the available diagnostic criteria. The diagnosis requires the exclusion of cerebral and retinal infarction, structural changes in the brain, epilepsy, and psychiatric symptoms. Triptans may be deleterious, anticoagulants are not indicated, and therapy with acetazolamide, valproic acid, zonisamide, furosemide, cortisone, and ketamine may be beneficial. Persistent aura without infarction is a challenging diagnosis. However, an approach using zonisamide and ketamine might be beneficial. Randomized and controlled clinical trials are required for a better comprehension of the aetiopathogenesis and therapeutic approach.