Persistent aura without infarction.
Current opinion in neurology June 1, 2025 Maurizio Severino, Mark W Green
Persistent aura without infarction is a rare, disabling but benign condition that spans neurology, neuro-ophthalmology, and psychiatry. It is likely caused by cortical spreading depression and vasoconstriction, and its clinical features often do not fit neatly into existing diagnostic criteria. Diagnosis requires excluding cerebral and retinal infarction, structural brain changes, epilepsy, and psychiatric symptoms. Triptans may be harmful, anticoagulants are not indicated, and treatments such as acetazolamide, valproic acid, zonisamide, furosemide, cortisone, and ketamine may help. An approach using zonisamide and ketamine might be beneficial, but randomized controlled trials are needed.