Characteristic Symptoms of BAM

Basilar Artery Migraine is normally characterized by a severe headache that often occurs in the occipital region (near the base of the skull in the back of the head), although the pain may also be in the region of the temporal lobe (above and just forward of the ear) and/or the eye (usually a bit above and behind the eyeball itself). Though the headache is normally present in some form, Basilar Artery Migraine can occur without one.

BAM is normally distinguishable from other disorders by its inclusion of visual, cerebellar, and brainstem disturbances. It often leads to syncope (fainting), and may either precede or accompany a headache.

Symptoms and Differential Diagnosis

In making a differential diagnosis for Basilar Artery Migraine, neurologists should look for the presence of two or more of the typical symptoms, which include vertigo, tinnitus, decreased or impaired hearing, ataxic gait, dysarthria, visual symptoms (normally in both eyes), diplopia, bilateral paresthesias or paresis, and impaired consciousness. These symptoms are usually, although not necessarily, followed by a throbbing headache in the occipital region (the back of the head). The vertigo that accompanies Basilar Artery Migraine normally lasts between 5 minutes and one hour.

The range of neurological symptoms associated with Basilar Artery Migraine are listed below. Please note that some of these are quite rare, even in BAM, and are representative of only the most severe cases of this neurological disorder. All of these symptoms certainly do not exist in all BAM cases. Most of the time, whatever symptoms are present are transient in nature. However, some BAM symptoms may last longer than the actual BAM duration. This may mean over 24 hours, or, in rare cases, a period of weeks or more. Such lasting, or "residual," neurological deficits associated with BAM will be discussed elsewhere in this document.

The Headache Normally Associated With BAM

The headache associated with BAM is usually quite severe. Even though the headache "portion" of a BAM attack can be severe and quite painful, it is often of secondary concern to the patient, due to the disabling and often frightening nature of the other symptoms. It is also not uncommon for someone having a Basilar Artery Migraine attack to not experience the headache itself during or after an attack. One very common reaction of both patients and those who happen to observe a Basilar Artery Migraine attack is that the patient is having a stroke.

Neurologial Deficits and BAM

The neurological deficits accompanying BAM usually include partial or total greying or loss of vision, disturbances in oculomotor function (such as double vision), vertigo, tinnitus (ringing in the ears), ataxic gait (difficulty in walking), paralysis on one side of the body, altered consciousness (may include amnesia, confusion, stupor, and/or syncope (loss of consciousness)), ptosis (drooping eyelid, usually on one side of the body). and parasthesias (altered sensation and tingling) on one or both sides of the body.

Those Symptoms Indicating Vertebrobasilar Ischemia

These specific symptoms were discussed in the Background and Basics section, and are repeated here. These symptoms of ischemia are some of the important factors in differential diagnosis, and are what makes the Basilar Artery Migraine appear to be similar to a stroke.

• dizziness and/or vertigo
• unsteadiness, difficulty walking, or loss of balance
• double vision
• partial blindness or blindness in both visual fields
• slurred speech and/or inability to speak (expressive aphasia)
• loss of feeling, tingling, or numbness of face and/or extremities
• weakness, paralysis, and/or "clumsiness" of extremities
• difficulty swallowing/inability to swallow and/or drooling

Visual Disturbances and Symptoms

Visual disturbances may be similar to those experienced in normal migraines. They may involve "metamorphosia" (distorted shapes in the visual field, normally moving), "hemianopsia" (blind spots in the visual field, usually moving and more often "positive" or bright than "negative" or dark), and "photoposia" (bright "flashes" that may appear to be flickering, shimmering, or in the pattern of zig-zag lines). In addition, as described below, either partial or total blindness may accompany an attack.

More to come here...

Scotoma

The scotoma seen in regular migrane with aura are not as common in Basilar Artery Migraine. Scintillating scotoma (sometimes described as "seeing stars") don't necessarily accompany Basilar Artery Migraine. In fact, it is more common for either positive or negative scotoma to be present than for scintillating scotoma to be. A type of negative scotoma experienced may be described as a "graying of the visual field," where the visual field starts to fade and become grayish. Scotoma may also be experienced as round or crescent-shaped moving deficits in the visual field, either negative (dark) or positive (light). Patients may also describe "blobs," either dark or light, in the visual field.

More to come here...

Partial or Complete Blindness

Normally in both eyes in the case of Basilar Artery Migraine. This is one of the differentiating factors that may be used in diagnosing BAM as different from other types of migraine.

The blindness is temporary (with the rare exception of lasting or permanent visual deficits resulting from stroke). It may be partial (see descriptions of other visual neurological disturbances) or complete. Partial blindness may be related to experiencing of "negative scotoma" (graying of the visual field). It may also take the form of hemianopsia (blind spots, either bright or "positive, " or dark or "negative," and usually moving through the visual field) or metamorphosia (distorted shapes, usually moving).

In some rare and severe cases of BAM, the patient experiences total loss of vision, usually during what they may describe as the "worst part" of the attack, where there may also be a loss of other senses and a loss of sense of self and sense of reality, as well as a very real feeling of impending death (the patient actually feels as if they are dying, and may lose consciousness and/or enter a coma soon thereafter). Loss of vision is normally transient, even in severe cases, though some BAM patients who do suffer visual disturbances during BAM and have, in addition, suffered strokes as a result of BAM have been left with permanent visual deficits.

More to come here...

Diplopia

Diplopia is another term for "double vision."

Neurological Signs Related to Speech and Language

Expressive Aphasia

Receptive Aphasia

Slurred Speech

Vestibular Disturbances (Disturbances of Hearing and Balance)

Hearing Loss

Tinnitus

Tinnitus is commonly called "ringing in the ears."

Dizziness

Vertigo

Vertigo is relatively commonly experienced in Basilar Artery Migraine. In fact, it is one of the "warning flags" that should alert a doctor or neurologist to the possibility of Basilar Artery Migraine. Though dizziness may occur in both normal migraines and in BAM, actual vertigo is something quite different, and is indicative of vertebrobasilar ischemia. Vertigo is more than "dizziness." It is the sensation that either the world around the patient is spinning or turning, or that the patient is spinning or turning in relation to their environment.

True vertigo, as opposed to forms of dizziness, faintness, or light-headedness, results from a disturbance somewhere in the equilibratory apparatus. This may include the vestibule, 8th nerve, semicircular canals, vestibular nuclei in the brainstem and their temporal lobe connections, or eyes. In the case of Basilar Artery Migraine, vertigo is likely caused by disturbance of the vestibular nuclei in the brainstem. The circulatory disorder that normally results in vertigo is transient vertebrobasilar ischemic attacks (as seen in Basilar Artery Migraine). Neurological disorders that may result in vertigo include multiple sclerosis, skull fracture, temporal lobe seizures,and encephalitis.

More to come here...

Neurological Deficits Related to Consciousness

Confusion and Disorientation (common)

Altered State of Consciousness

Stupor

Angor Animi (rare) (sense of impending death)

Sense of Impending Loss of Consciousness

Syncope

Syncope is the medical term for "fainting." A faint is a temporary loss of consciousness that lasts anywhere from a few seconds to a several minutes. The person who faints normally regains consciousness naturally after such time and without assistance.

More to come here...

Amnesia (Transient and/or Transient Global Amnesia (TGA)

Derealization

Depersonalization

Coma (rare)

Disturbances in Homeostasis

More to come here...

Feverishness and Episodic Fever

More to come here...

Profuse Sweating

More to come here...

Marked Change in Vital Signs

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Lowered Body Temperature

More to come here...

Neurological Signs and Motor Deficits

More to come here...

Ataxic Gait

More to come here...

Drop Attacks (rare)

More to come here...

Unilateral or Bilateral Numbness

More to come here...

Hemiparesis (unilateral motor deficits and/or weakness)

More to come here...

Tingling around mouth and/or nose

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Parasthesia (tingling or other sensory sensations spreading up or down limbs)

More to come here...

Dysethesia (painful tingling sensations)

More to come here...

Other Signs and Symptoms

Episodic mood changes

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Nausea

More to come here...

Vomiting

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Coronary Artery Spasm (Coronary Angina)

More to come here...

Abdominal Pain

More to come here...

What are the symptoms of TIA and how can a doctor tell if you have had one?

Symptoms of Transient Ischemic Attacks

Symptoms of TIA are similar to those of stroke. TIAs are characterized by their sudden appearance. They normally last from 2 to 30 minutes. It is rare for one to last more than one or two hours. They abate without continuing symptoms. Those suffering from TIAs do not lose consciousness during any part of the attack. If a TIA lasts for hours, the person may have suffered an infarction. Even without neurologic abnormalities that do not persist, such infarctions may appear on subsequent MRI and/or CT scans.

The specific signs and symptoms of TIA depend on the arterial system, and subsequently the part of the brain, affected.

TIA With Carotid Artery System Involvement

If the carotid artery system is the source of the ischemic attack, then most of the symptoms experienced will be unilateral (on one side of the body). Classical TIA symptoms include "ipsilateral blindness" (blindness on the same side) and "contralateral hemiparasis" (hemiparesis on the opposite side of the body). Aphasias, if involved, indicates the involvement of the dominant hemisphere of the brain. The patient may also experience slurred speech. Carotid artery TIAs are more common than those involving the vertebrobasilar system and the brainstem.

TIA With Vertebrobasilar System Involvement

When the vertebrobasilar system is involved, the TIA symptoms seen reflect what is called "brainstem dysfunction." These symptoms include confusion, vertigo, binocular blindness, and diplopia. In addition, unilateral weakness, or, more often, bilateral weakness (weakness on both sides of the body), along with paresthesias of the extremities may be present. A patient suffering from TIA involving the vertebrobasilar system may have what are known as "drop attacks." This is where the legs buckle, usually leading to a fall. Drop attacks are often attributed to vertebrobasilar ischemia, even though there is no hard proof that this is indeed the cause. Slurred speech (dysarthria) may also occur with involvement of the vertebrobasilar system, as in TIA involving the carotid artery system.

TIAs with vertebrobasilar involvement are normally the type of TIA seen with BAM. The vertebrobasilar and brainstem ischemia experienced during a BAM attack may not necessarily be called TIA by a treating physician, but it is indeed a form of TIA. To be more specific, it is a "transient vertebrobasilar ischemic attack" as opposed to a common TIA.

Those Patients With Repeated Attacks

Patients suffering from Transient Ischemic Attacks have a wide range of frequency of attacks. Some may have more than one TIA (some, even several), and others may have only one or two over a period of several years. Some people may have one TIA and never experience another.

The symptoms of the attacks themselves are usually similar from attack to attack in those persons who suffer from carotid artery TIAs. However, for those who suffer from vertebrobasilar TIAs, it is common for the specific symptoms to differ from one attack to another.

It is unknown exactly how often TIAs in general actually precede or forewarn of a stroke. Stroke appears, however, to be more likely in those who suffer carotid artery TIAs than in those who suffer vertebrobasilar TIAs.

A Note on Causes of TIA in BAM Versus Traditional Causes and Risk Factors

More to come here...

The American Academy of Neurology Definition of Transient Ischemic Attack

A transient ischemic attack (TIA) is an episode of neurological dysfunction, resembling a stroke except that it develops suddenly, lasts less five minutes to several hours (not usually more than 24), and resolves completely. Symptoms are caused by disruptions of blood flow to the brain and reflect the areas of the brain served by the blocked blood vessel.

Getting More Information on TIA

More info on TIA can be found by doing web searches on the topic, or by looking up some stroke sources. You might try NINDS or NSA (organizations), too. I believe most diagnoses of TIA result from getting appropriate history from the patient. With BAM/TIA, it is most helpful if you can write down, remember, record, or have someone who was there pass on info of any events, attacks, seizures, or symptoms.

More to come here... including hyperlinks to organizations providing information on TIA and stroke.

Residual Neurological Deficits and BAM

Short-term Residual Neurological Deficits

RIND (Reversible Ischemic Neurological Deficits)

Stroke and Permanent Neurological Deficits