Persistent aura without infarction.

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.

Study at a glance

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.