Sunday, February 20, 2011

Serena Branson and complex migraines

It turns out that after two days of extensive testing, Serena Branson's aphasia was diagnoses as a complex migraine. What she has stated in an interview is that she had not been feeling well with a sense of tiredness and the onset of a headache before the speech disturbance began. That was a big clue. Never-the-less a full work-up needed to be done, including MRI of the brain, MRA (MR angiography, looking at the blood vessels) of the neck and the brain, EKG and echocardiogram as well as blood tests. When it was found that all of these tests were normal than the symptoms could be utilized to make the final diagnosis.

So how could a migraine cause the symptome of speech dysfunction? First, the phenomenon of migraines needs to be understood. Fundamentaly, the arteries in the brain constrict in the first phase (prodromal phase) and then dilated. Though the constriction may cause some headache, the dilation phase is generally what causes the severe headache. When the blood vessels dilate, there can be a reduction in blood flow to the area of the brain most affected. Depending on which area is affected, symptoms related to that area develop. This is referred to as an aura. If it occurs in the occipital area which has to do with vision, then the aura will included symptoms such as seeing spots, flashing lights, zigzags or moving lines, like blades of a fan. This usually lasts minutes but can last up to almost an hour. If it affects the prefrontal gyrus which controls movement then there may be problems with movement of a limb or with the face. When it effects Broca's area in the base of the posterior frontal lobe, then, though the individual may know what they want to say, they can not get it out coherently. This is exactly what happened with Serena Branson. Many other symptoms may also occur such as tingling, confusion, even hallucinations. Following this aura, the migraine headache usually ensues but it may not always occur so when it is only the aura which is the significant symptom, it may be difficult to diagnose until other causes of the neurologic dysfunction are excluded. Rarely, the vasospasm and reduction in bloodflow can be so severe that a stroke can occur. When auras occur regularly and can be temporarily disabling then medication can be used such as inderal to limit these troubling events.

Those who suffer from these symptoms should meet with a neurologist to find the right treatment including avoiding triggers such as certain foods or even odors or scents.

Wednesday, February 16, 2011

Serena Branson's Speech Arrest

America witnessed a dramatic ezample of speech arrest or expressive aphasia when Serena Branson began speaking incoherently when reporting on the Grammies while on- air. According to news reports, her symptoms resolved within a few minutes at the most and she refused further medical assistance after the paramedics found her vital signs to be stable. There is great interest in knowing what could have caused a dramatic and sudden but thankfully brief loss of speech.

There are numerous possible causes of sudden aphasia that fully resolves. These include transient ischemic attacks, seizures, brain hemorrhages, low blood pressure, low blood sugar, multiple sclerosis and inflammatory conditions of the brain and blood vessels.

What comes to mind first is a transient ischemic attack (TIA). This is due to a brief reduction of blood flow to a portion of the brain but with resumption of adequate blood flow before damage to that area occurs. The reduction in blood flow can be due to a piece of "debris" breaking off a plaque in a narrowed, diseased artery in the neck or when there is such a high degree of narrowing of an artery in the neck or brain that briefly the blood flow through that artery is profoundly reduced. These events usually occur in individuals over the age of sixty. Another cause of TIA can be due to an abnormality in the heart such as an infection in the heart or an abnormal heart rhythm. In these instances a small piece of "debris" can be released from the heart into the blood stream and then into the brain. A TIA can also be caused by birth control pills, blood disorders and drugs such a cocaine. Inflammation of arteries, refered to as arteritis is another cause of TIAs.
TIAs are highly significant because they are often precurors of major strokes leading to permanent neurologic dysfunction. Therefore, it is important to diagnose the cause of a TIA and treat it appropriately and rapidly.

A focal seizure can present as a brief loss of neurologic dysfunction including a brief episode of aphasia as Serena Branson experienced. Again, there are numerous possible causes for the new onset of a seizure. A brain tumor, drug reaction, brain hemorrhage or low blood sugar are all possible causes of a focal seizure.

Even when someone recovers fully and feels well after an brief episode of aphasia, as apparently was the case with Serena Branson, the individual needs a full and careful medical evaluation. Not only do they need an MRI of the brain, which may, in fact, be normal but the arteries in the neck and the heart need to be fully evaluated. Additionally blood tests need to be performed. Without appropriate diagnosis and treatment, a permanent stroke could ensue or a minor hemorrhage in the brain could lead to a major hemorrhage. If a seizure has occured, a subsequent seizure might be more profound. The early stage of an infection such as encephalitis could become a life-threatening infection of the brain.

Certainly Ms. Branson will have a thorough medical evaluation and hopefully the cause of her episode of aphasia will be found to be readily treatable and she will not suffer future neurologic dysfunction.