A 31-year-old woman with migraine had reversible rightsided hemiplegia followed by a throbbing headache on the left side, and underwent a series of MRI scans over an 18-day period.
Hemiplegic migraine is a rare subtype of migraine with aura, presenting with a completely reversible unilateral weakness associated with migraine. This disorder usually has a familial autosomal dominant inheritance trait but, like our patient, can be sporadic. An MRI can show cortical edema, with sulcal hyperintensity on FLAIR (Figure), this being rare and of uncertain etiology, possibly due to increased vascular permeability during the aura phase mimicking subarachnoid hemorrhage11. Russell MB, Ducros A. Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. Lancet Neurol. 2011;10(5):457-70. https://doi.org/10.1016/S1474-4422(11)70048-5
https://doi.org/10.1016/S1474-4422(11)70...
,22. Gómez-Choco M, Capurro S, Obach V. Migraine with aura associated with reversible sulcal hyperintensity in FLAIR. Neurology. 2008;70(24 pt 2):2416-8. https://doi.org/10.1212/01.wnl.0000314693.57386.f0
https://doi.org/10.1212/01.wnl.000031469...
,33. Bosemani T, Burton VJ, Felling RJ, Leigh R, Oakley C, Poretti A et al. Pediatric hemiplegic migraine: role of multiple MRI techniques in evaluation of reversible hypoperfusion. Cephalalgia. 2014;34(4):311-5. https://doi.org/10.1177/0333102413509432
https://doi.org/10.1177/0333102413509432...
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References
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1Russell MB, Ducros A. Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. Lancet Neurol. 2011;10(5):457-70. https://doi.org/10.1016/S1474-4422(11)70048-5
» https://doi.org/10.1016/S1474-4422(11)70048-5 -
2Gómez-Choco M, Capurro S, Obach V. Migraine with aura associated with reversible sulcal hyperintensity in FLAIR. Neurology. 2008;70(24 pt 2):2416-8. https://doi.org/10.1212/01.wnl.0000314693.57386.f0
» https://doi.org/10.1212/01.wnl.0000314693.57386.f0 -
3Bosemani T, Burton VJ, Felling RJ, Leigh R, Oakley C, Poretti A et al. Pediatric hemiplegic migraine: role of multiple MRI techniques in evaluation of reversible hypoperfusion. Cephalalgia. 2014;34(4):311-5. https://doi.org/10.1177/0333102413509432
» https://doi.org/10.1177/0333102413509432
Publication Dates
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Publication in this collection
Dec 2017
History
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Received
24 Dec 2016 -
Reviewed
11 Aug 2017 -
Accepted
28 Aug 2017