Migraine aura or transient ischemic attacks? A five-year follow-up case-control study of women with transient central nervous system disorders in pregnancy

<p>Abstract</p> <p>Background</p> <p>Migraine aura may be difficult to differentiate from transient ischemic attacks and other transient neurological disorders in pregnant women. The aims of the present study were to investigate and diagnose all pregnant women with transient neurological disorders of suspected central nervous system origin, and to compare this group with a control group of pregnant women with regard to vascular risk factors and prognosis.</p> <p>Methods</p> <p>During a 28 month period, 41 patients were detected with transient neurological symptoms during pregnancy. These were studied in detail with thorough clinical and laboratory investigations in order to make a certain diagnosis and to evaluate whether the episodes might be of a vascular nature. For comparison, the same investigations were performed in 41 pregnant controls. To assess the prognosis, both patients and controls were followed with questionnaires every year for five years.</p> <p>Results</p> <p>Migraine with aura was the most common cause of symptoms during pregnancy, occurring in 34 patients, while 2 were diagnosed with stroke, 2 with carpal tunnel syndrome, 1 with partial epilepsy, 1 with multiple sclerosis and 1 with presyncope. Patients had more headache before pregnancy than controls, but the average levels of vascular risk factors were similar. None of the patients or the controls reported cerebrovascular episodes during the five-year follow-up.</p> <p>Conclusion</p> <p>The diagnosis of migraine aura was difficult because for many patients it was their first ever attack and headache tended to be absent or of non-migraineous type. The aura features were more complex, with several aura symptoms and a higher prevalence of sensory and dysphasic aura than usual. Gradually developing aura symptoms, or different aura symptoms occurring in succession as described in the International Classification of Headache Disorders, seem to be useful for differentiating aura from other transient disorders. A meticulous history and clinical neurological examination are more useful than routine supplementary investigations for cerebrovascular disease. The five-year follow-up clearly indicates that migraine with aura in pregnancy usually has a good prognosis with regard to cerebrovascular events.</p

The Role of the Submerged Prehistoric Landscape in Ground-Truthing Models of Human Dispersal During the Last Half Million Years

Human genome analysis and research into fossil anthropogenic nuclear DNA and mitochondrial DNA are providing many new insights into hominin diffusion and migration over the past half million years. The beginning and end data on migration routes frequently imply that the migration involved crossing a present sea-channel or marginal basin, or migrating along the present continental shelf. However, there are very few attempts to correlate the models based on DNA with in situ archaeological and palaeoenvironmental data from the continental shelf or shelf marginal seas. Yet a significant number of sites are available for such correlation. Over 3000 submerged prehistoric archaeological sites on the continental shelf are known worldwide, varying in depth from the nearshore to about −100 m and ranging in age from 5000 years to >0.5 million years. Sites have been found off the coast of every continent except Antarctica. Most of the sites found so far are shallower than 10–20 m, with a few deeper than 40 m, and none are in the tropics. The submerged sites found so far exist in a very wide range of taphonomic conditions and climatic zones, confirming that sites could be found to provide empirical tests of the many different proposed migration routes. The principal exception is that no sites have yet been found between the Tropics of Cancer and Capricorn and the so-called Southern Route cannot yet be checked until the submerged landscape has been mapped in sufficient detail indicating where sites might survive and be identified. In all other geographic regions it is recommended that DNA models and seabed data are examined for consistency and mutual benefit. Further work is needed to identify submerged sites and landscapes in the tropics