Challenges in the Differential Diagnosis of Transitory Ischemic Attack and Migraine with Aura in 14-Year-Old Adolescent: Case Study

Background. Transitory ischemic attacks (TIA) remain a significant public health problem in the pediatric population. The difficulties of diagnostics of TIA in children and the high risk of recurrence (up to 40%) are due to the lack of standards for the patients management, as well as the similarity of the clinical manifestations of TIA with other paroxysmal states (migraine with aura, for example).

Case description. A 14-year-old girl was admitted to the hospital in the home area, complaints: headaches, blurred vision (a “light line” in the left F.V.), numb feeling of the left hand, lasts up to 2.5 hours. Diagnosis: migraine with aura. At the checkup the carrier state of variants of six genes (FGB, F13, ITGA2, PAI-1, MTR, MTRR) associated with thrombophilia was revealed, as well as hypoplasia of the right vertebral artery, Kimmerle anomaly with extravasal compression, atrial septal defect, and bradycardia. Recurrent TIAs were diagnosed in the vertebrobasilar territory. Acidum acetylsalicylicum (75 mg/day) was prescribed as per the off-label, with complete relief of TIA episodes for 2 years. Withdrawal of the drug provoked a recurrence of TIA. The resumption of Antiplatelet therapy ensured the onset of remission.

Conclusion. Diagnostics of TIA in children is a complex clinical case which requires to exclude a wide range of diseases (migraine with aura, epilepsy, demyelinating diseases). To diagnose the TIA promptly doctors need to remain alert to cerebrovascular pathology, they also need an interdisciplinary step-by-step approach, and analyze the risk factors (thrombophilic gene variants, vascular anomalies, and cardiac pathology). When prescribing antiplatelet therapy to children with TIA doctors conduct the laboratory efficacy monitoring (ASPI test), when discontinuing the therapy doctors assess the risk/benefit ratio due to high risk of relapse.

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