Middle cerebral artery occlusion with migraine

Ischemic stroke and migraine in childhood: coincidence or causal relation?

Although migraine is an accepted cause of cerebral infarction in adults, this association is less well recognized in children. We present two children with migraine and cerebral infarction, which we regard as migrainous stroke, though neither patient fulfills all criteria of the International Headache Society for the diagnosis of migrainous infarction. Review of the literature concerning examples of migraine-associated stroke in childhood suggests that these criteria are too restrictive to comprise the majority of migrainous strokes, especially in this age group.

Intracerebral vascular occlusion in familial erythrophagocytic lymphohistiocytosis: a case report of two siblings

Neuropathological findings in two siblings with familial erythrophagocytic lymphohistiocytosis (FEL) are reported. Case 1 showed the typical neuropathological findings of FEL with lymphohistiocytic infiltration of the leptomeninges and perivascular spaces. A characteristic erythrophagocytosis was detected in inguinal lymph nodes, lung and bone marrow. Case 2 revealed calcification and necrotic lesions in the brain. In the necrotic areas, parenchymal calcification, vascular medial calcification, and occlusion of many vessels due to subendothelial fibrosis were detected. The areas of necrosis correlated with the distribution of occluded vessels. These changes were most prominent in putamen, internal capsule, thalamus and dentate nucleus. Hypercytokinemia is suspected to be the underlying mechanism for the clinical and laboratory findings in patients with FEL, although the relationship to the vascular pathology is unclear.

Migraine and stroke in childhood and adolescence

Over 3 years we evaluated two patients, an adolescent and a child, with migraine-like headache and ischemic stroke. Based on our clinical observations and on literature review of migraine and stroke in the pediatric age group, we believe that the criteria of migrainous infarction outlined by the International Headache Society (IHS) could be occasionally too restrictive. Therefore, we suggest subclassifying migrainous infarction into: (i) "definite", referring to the patients whose ischemic stroke fulfills all the IHS criteria, (ii) "possible", referring to ischemic strokes which fulfill some, but not all, criteria. This subclassification of migrainous infarction may be relevant in clinical practice and in human research studies.

[Striatocapsular infarction in childhood. Report of 4 cases]

The authors present the study of four children that manifested asymmetric hemiparesis with sudden onset, without consciousness loss. The diagnosis of striatocapsular infarction was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The clinical and neurological examination, and laboratorial results are discussed. Familial history of migraine was found in two of the patients. Migraine was diagnosed in two, mild head trauma, viral miocarditis and mitral valve prolapse in one. Left hemiparesis, with brachiofacial features in three, and brachial in one. CT showed lenticular nucleus and internal capsule lesions in all of them, head of caudate nucleus in three, and white substance in two. MRI was done in two and confirmed CT findings. Electroencephalogram, at the acute phase in three, showed abnormalities in all patients.

Intracerebral hemorrhage associated with migrainous headache--a case report

A case of intracerebral hemorrhage that developed some time after severe headache is reported in a relatively young woman. It is proposed that hemorrhage may also be included among the causes of so-called migraine-related stroke, which has generally been known to result from infarction.

The influence of acetazolamide on cerebral low-flow regions in migraine--an interictal 99mTc-HMPAO SPECT study

Acetazolamide, a carbonic anhydrase inhibitor, has proved to be useful in the assessment of "vasodilatory capacity" in cerebrovascular disease. To obtain further information on the nature of interictal low-flow regions in migraine, we reinvestigated 20 asymptomatic patients suffering from migraine with aura (n = 15) or without aura (n = 5) and who had either minor (n = 12) or marked (n = 8) regional hypoperfusion when examined in a previous 99mTc-HMPAO SPECT investigation. These patients received acetazolamide IV prior to tracer application. In 14/20 cases regional hypoperfusion resolved. Three patients with migraine with aura had less pronounced regional hypoperfusion compared to baseline. No change in baseline hypoperfusion was detectable in three older patients. No further decreases in flow were measured. In contrast to patients with cerebrovascular ischemia, in whom acetazolamide usually enhances low-flow regions, vasodilatory capacity appears intact in most migraine patients with interictal regional hypoperfusion. Thus, the "acetazolamide test" might be useful in the differential diagnosis of migraine with aura from transient cerebrovascular ischemia.

Does migraine-related stroke occur in childhood?

This report concerns seven children who had at least one episode of infarct, possibly during an attack of migraine. They fulfilled the following criteria: presence of acute neurological deficit associated with headache or other symptoms characteristic of migraine attacks; a history of migraine; evidence of infarct on CT scan; and no other evident cause of the stroke. CT showed that the area of infarction was in the distribution of the posterior cerebral artery in three cases. Four of the children have been followed for at least 23 months and none has severe residual deficit. An aetiological relationship between migraine and stroke could not be demonstrated. However, epidemiological data suggest that childhood migraine can be a contributory risk-factor for strokes.

[Clinical symptoms and classification of migraine.]

Since the beginning of the history of man migraine has been described in all civilizations. It would therefore seem helpful if migraine were to be classified, for diagnostic reasons and in order to study the scientific hypotheses, according to the manifold clinical symptoms, as well as the lack of typical pathophysiological, morphological and biochemical findings. In this review the new classification of headache forms according the the International Headache Society (1988) is presented in comparison to earlier classifications, with special attention to migraine. On the basis of this classification, the individual forms of migraine are described from the viewpoint of the clinical symptoms. The classification of the International Headache Society represents a good basis for reclassifying headaches, which is still under discussion.

Ischaemic stroke in the basal ganglia and internal capsule in childhood

Ischaemic stroke in childhood is rare. In particular, there have only been a few reports of lacunar infarcts in children. In this study, four children with true lacunar infarcts and four with larger subcortical infarcts are described. We compare the clinical features and the possible pathogenesis of ischaemic strokes in the basal ganglia and internal capsule in childhood with those in adults, and discuss diagnostic and therapeutic management.

Trauma-triggered migraine: an explanation for common neurological attacks after mild head injury. Review of the literature

This paper reviews the literature on complex temporary disturbances of brain function triggered by mild blows to the head in children, adolescents, and young adults. It consolidates the evidence by which these attacks have been identified as classical or complicated migraines, and provides a historical account of the descriptions and proffered explanations of these attacks. The clinical features and the electroencephalography, angiography, computerized tomography, and cerebrospinal fluid findings of trauma-induced migraine are presented and compared to those of spontaneous migraine. Ideas about the pathogenesis of this condition are related to current thinking on the neurological phenomena of migraine in general.

Clinical features and mechanism of occipital infarction

To clarify the clinical features and mechanism of infarction in the posterior cerebral artery territory, we investigated 35 consecutive patients who presented with homonymous visual field defects and occipital infarction documented by computed tomography. Cerebral angiographic findings in 23 patients, and the clinical features of rare transient ischemic attacks and maximal deficit occurring at stroke onset, were consistent with embolism of the posterior cerebral artery. Visual field defects were the only neurological abnormality in 17 patients; the remainder had additional findings. Three patients had a major brainstem stroke. Stroke in the posterior cerebral artery territory was found in a heterogeneous group of patients, although embolism was the most common stroke mechanism. Several distinct patient groups were identified: cardiac source embolism (10 patients), vertebrobasilar atheroma with local embolism (6), migraine (5), systemic illness with presumed coagulopathy (3), and "unknown source embolism" after negative cardiac investigation (11 patients). During follow-up, 26 patients had no further neurological events (the majority on anticoagulation or antiplatelet treatment), 3 suffered new strokes, and 6 died.

[Complicated migraine: apropos of 3 cases]

After brief considerations about complicated migraine, three cases are reported. The diagnosis was made by the clinical features and by computed tomography. The term complicated migraine must be reserved for those cases in which the neurological symptoms and signs outlast migraine attack for more than 24 hours or in which permanent deficit develops because of cerebral or brainstem infarction. Other criteria for diagnosis is the presence of infarction in CT scanning, although prolonged or permanent deficit are absent. The possible role of platelet aggregation, vascular spasm and increased coagulability of the blood, as the cause of infarction, is discussed. All the patients in this report showed prolonged neurological deficit and infarction in CT scanning.

Ischemic strokes and migraine

The coincidence of migraine and ischemic strokes is rare but unequivocal. Some of the cases described are recalled and the possible mechanisms discussed.

Vertebrobasilar occlusive disease and childhood migraine

A nine-year-old girl developed a cerebellar infarct documented by computed tomography. This infarct occurred in association with a typical migrainous attack. Vertebrobasilar occlusive disease has been reported in adult migraineurs but has not been previously reported in children.

[Cerebral angiography in complicated migraine--reactions, incidents]

Seventy-one patients (ages: 15-58 years) suffering from complicated migraine were investigated by means of cerebral angiography which was not performed during an attack. Angiography was carried out to exclude stenoses or occlusions of the cranio-cervical vessels and above all vascular malformations (arterial aneurysms, arteriovenous angiomas). In 18 cases (25.4%) organic lesions were found, including three vessel malformations (4.2%). Thirty-one patients (43.7%) suffered from headache reactions or other complications during or within 24 h following angiography. In 15 cases (21.1%) attacks of complicated migraine were observed, three patients (4.2%) suffered from headache and bilateral flickering visual disturbances, another 11 patients (15.5%) developed headache and vegetative symptoms requiring therapeutic management. One patient (1.4%) got an epileptic seizure, another patient (1.4%) developed a generalized urticaria exanthema. There were more headache reactions in women than in men. However, the highest percentage of reactions was observed in patients in whom migraine headache had occurred clearly set off from the transient cerebral functional disturbances. Neurological complications (transient functional disturbances) occurred in 16 of 71 patients (22.5%). The neurological complication rate was significantly (P less than 0.001) higher than that in an unselected group of patients (3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)