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Lebedeva ER, Gurary NM, Olesen J. Diagnosis of Migrainous Infarction: A Case Report and Analysis of Previously Published Cases. Diagnostics (Basel) 2023; 13:2502. [PMID: 37568864 PMCID: PMC10416890 DOI: 10.3390/diagnostics13152502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Migrainous infarction (MI) is a rare disorder. The precise diagnostic criteria for this diagnosis have been available in the International Classification of Headache Disorders (ICHD) since 1988, but many cases do not fulfil these criteria. This paper describes a good example of MI and analyzes previously published case reports. We report a very special case of MI in an 18-year-old woman who had a recurrent episode of migraine with a similar aura with numbness of the right arm and speech disturbances which had an unusually long duration (>120 min). On admission to the headache centre "Europe-Asia", she complained of slowness of speech and problems with choice of words. An MRI showed acute lacunar infarcts in the left parietal subcortical area. Ischemic infarcts were localized in a relevant area on the left side and the aura symptoms were right-sided. The patient, therefore, fulfilled the ICHD-3 diagnostic criteria for "Migrainous infarction". An analysis of 35 previously published articles with case reports about MI showed that 22 did not meet the diagnostic criteria of the ICHD for migrainous infarction. Using all this, we developed diagnostic recommendations for migrainous infarction which can help to improve the quality of diagnosis when used together with the diagnostic criteria of the ICHD for migrainous infarction.
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Affiliation(s)
- Elena R. Lebedeva
- Department of Neurology, The Ural State Medical University, 620028 Yekaterinburg, Russia
- International Headache Centre “Europe-Asia”, 620144 Yekaterinburg, Russia
| | | | - Jes Olesen
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, 1172 Copenhagen, Denmark
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Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019. [PMID: 31695483 DOI: 10.2147/jpr.s209485.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
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Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
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Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019; 12:2941-2950. [PMID: 31695483 PMCID: PMC6814312 DOI: 10.2147/jpr.s209485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 02/05/2023] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
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Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
- Correspondence: Luisa Vinciguerra Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124Messina, ItalyTel +39 090 6012 8395Fax +39 090 6012 8850 Email
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
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Khardenavis V, Karthik DK, Kulkarni S, Deshpande A. Cortical laminar necrosis in a case of migrainous cerebral infarction. BMJ Case Rep 2018; 2018:bcr-2017-221483. [PMID: 29592973 DOI: 10.1136/bcr-2017-221483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We report a 27-year-old woman, a known case of classical migraine headache, on oral contraceptive pills. She had a severe episode of migraine with visual aura attack, which continued late into the night. The next early morning, her headache persisted and she developed abrupt onset of dysarthria, right hemiparaesthesias. She attributed symptoms to her long-standing headache problem, and hence did not seek medical help for the next two weeks. The symptoms persisted despite her headache subsiding over the next 24 hours. She worsened 2 weeks later during another such episode of headache. This time, she developed right hemiparesis. The patient was admitted with provisional diagnosis of stroke. MRI of the brain showed left temporoparietal lesion and was radiologically compatible with cortical laminar necrosis.Extensive work-up was done to rule out other causes of young stroke. The patient improved with antiplatelets, antimigraine prophylaxis and stroke rehabilitation therapy.
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Affiliation(s)
| | | | - Sharvari Kulkarni
- Maharashtra Institute of Medical Education and Research, Pune, Maharashtra, India
| | - Anirudda Deshpande
- Department of Neurology, Vinayaka Neuro Multispecialty Clinic, Warangal, Telangana, India
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Morais R, Sobral F, Cunha G, Brito O, Santana I. Advanced MRI study of migrainous infarction presenting as cortical laminar necrosis - Case report and literature review. Clin Neurol Neurosurg 2018; 167:82-85. [PMID: 29471286 DOI: 10.1016/j.clineuro.2018.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/14/2017] [Accepted: 02/09/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Ricardo Morais
- Coimbra Hospital and University Centre - Medical Imaging Department, Portugal.
| | - Filipe Sobral
- Coimbra Hospital and University Centre - Neurology Department, Portugal
| | - Gil Cunha
- Coimbra Hospital and University Centre - Medical Imaging Department, Portugal
| | - Olga Brito
- Coimbra Hospital and University Centre - Medical Imaging Department, Portugal
| | - Isabel Santana
- Coimbra Hospital and University Centre - Neurology Department, Portugal
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Case 45. Neuroophthalmology 2017. [DOI: 10.1007/978-1-4471-2410-8_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Parks NE, Rigby HB, Gubitz GJ, Shankar JJ, Purdy RA. Dysmetropsia and Cotard's syndrome due to migrainous infarction – or not? Cephalalgia 2014; 34:717-720. [DOI: 10.1177/0333102414520765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Migrainous infarction accounts for 12.8% of ischemic strokes of unusual etiology. Case report A 59-year-old woman with longstanding migraine with aura experienced what appeared to be migrainous infarction characterized by dysmetropsia and transient Cotard’s syndrome. Imaging demonstrated right temporal-parietal-occipital changes with apparent cortical laminar necrosis. Conclusion The spectrum of the pathophysiology of migrainous infarction has not been established; however, cortical spreading depression may explain the appearance of imaging findings that do not obey a vascular territory.
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Affiliation(s)
- Natalie E Parks
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
| | - Heather B Rigby
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
| | - Gordon J Gubitz
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
| | - Jai J Shankar
- Department of Radiology, Dalhousie University, Canada
| | - R Allan Purdy
- Division of Neurology, Department of Medicine, Dalhousie University, Canada
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Arboix A, González-Peris S, Grivé E, Sánchez MJ, Comes E. Cortical laminar necrosis related to migrainous cerebral infarction. World J Clin Cases 2013; 1:256-259. [PMID: 24340278 PMCID: PMC3856303 DOI: 10.12998/wjcc.v1.i8.256] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/29/2013] [Accepted: 10/16/2013] [Indexed: 02/05/2023] Open
Abstract
We present a 29-year-old woman with a long history of attacks of migraine with and without visual aura. She was a heavy smoker (20 cigarettes/d) and was currently taking oral contraceptives. During a typical migraine attack with aura, she developed dysarthria, left brachial hemiparesis and hemihypoesthesia and brief and autolimited left clonic facial movements. Four hours after onset, vascular headache and focal sensorimotor neurological deficit were the only persisting symptoms and, on seventh day, she was completely recovered. Brain magnetic resonance imaging on day 20 after onset showed a subacute ischemic lesion in the right temporo-parietal cortex compatible with cortical laminar necrosis (CLN). Extensive neurological work-up done to rule out other known causes of cerebral infarct with CLN was unrevealing. Only ten of 3.808 consecutive stroke patients included in our stroke registry over a 19-year period fulfilled the strictly defined International Headache Society criteria for migrainous stroke. The present case is the unique one in our stroke registry that presents CLN related to migrainous cerebral infarction. Migrainous infarction can result in CLN.
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Shah L, Rana S, Valeriano J, Scott TF. Reversible CT perfusion abnormalities in patient with migraine variant: A two phase process. Clin Neurol Neurosurg 2013; 115:830-2. [DOI: 10.1016/j.clineuro.2012.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/10/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
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Goodwin D. Transient complete homonymous hemianopia associated with migraine. ACTA ACUST UNITED AC 2011; 82:298-305. [PMID: 21524601 DOI: 10.1016/j.optm.2010.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 10/31/2010] [Accepted: 12/28/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Because of the transient and rare nature, objective visual and neuroimaging evaluation during an acute, spontaneous attack of a migrainous aura causing a complete homonymous hemianopia has not been reported. CASE REPORT A healthy 27-year-old white woman with a history of typical aura with migraine presented during an episode of no light perception in the right hemifield of both eyes. Ophthalmic testing and neuroimaging were unremarkable. The visual field defect started to resolve 1 hour after initial symptoms, and significant improvement was seen after 4 hours. One year later, the patient had no visual field defects and had not experienced another episode of homonymous hemianopia. DISCUSSION More than one third of migrainous patients experience visual symptoms. Typical aura with migraine is diagnosed usually by history. Laboratory testing and neuroimaging are necessary if an alternative cause is suspected, i.e., the aura begins after age 40 years, negative features are predominant, or the aura is very short or prolonged. Correct diagnosis is critical, because conditions that mimic migrainous aura have potentially devastating consequences. Migraine with aura patients may have persistent visual field defects and are at an increased risk for stroke compared with nonmigraine patients. This case improves our knowledge of the nature of a transient homonymous hemianopia associated with migraine.
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Affiliation(s)
- Denise Goodwin
- Pacific University College of Optometry, Forest Grove, OR 97116, USA.
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Differential Diagnosis of Cerebral Hemispheric Pathology. Clin Neuroradiol 2011; 21:53-63. [DOI: 10.1007/s00062-011-0072-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 03/18/2011] [Indexed: 10/18/2022]
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Laminar cortical necrosis in mitochondrial disorders. Clin Neurol Neurosurg 2009; 111:655-8. [DOI: 10.1016/j.clineuro.2009.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 07/01/2009] [Accepted: 07/04/2009] [Indexed: 11/18/2022]
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