A seven-year-old boy with migraine and a family history of hemiplegic migraine is described who, during an exacerbation, developed dysphasia and right hemiparesis. A CT scan showed a hypodense left cerebral lesion. Angiography revealed occlusion of the left middle cerebral artery at its origin. This represents the youngest case of stroke with migraine and, to our knowledge, is the first case report of angiogram-documented middle cerebral occlusion associated with migraine. Stroke, Vol 13, No 3,

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... 1982 TRANSIENT NEUROLOGICAL DEFICITS sometimes accompany migraine headache. Hemiplegia, hemihypesthesia, aphasia, ophthalmoplegia, and visual field deficits during migraine may mimic transient ischemic attacks 1-7 and are manifestations of intracerebral vasospasm which, when prolonged, can result in seizure, infarction, or death. 8-16 CT scans of the brain have occasionally corroborated clinical evidence for focal infarction and edema occurring during migraine attacks." 17~18 Regional cerebral blood flow measurements have demonstrated focally-impaired hemispheric perfusion during migraine. 19 Nevertheless, despite convincing evidence for neurovascular instability, permanent neurological deficits are rarely suffered by migraineurs. In general, CT scans of the brain and cerebral angiography performed in cases of complicated migraine show no abnormalities. 6 ' 7 -,4 -20~22 While vasospasm has been visualized occasionally in migraine patients, 9 -12 -l3 complete occlusion of intracerebral vasculature has been demonstrated in only a small number of cases. 10, "• 15 In the following case, we report clinical and radiological evidence for complete occlusion of the left middle cerebral artery in a child who suffered from recurrent severe migraine headaches. This case corroborates evidence for vasospasm-induced intracerebral thrombosis and infarction which may occur in migraine. It underscores the importance as well as the difficulty of early diagnosis of this process in very young patients. Case Report The patient is a seven-year-old right-handed boy admitted to the Dartmouth-Hitchcock Medical Center for evaluation of mental status changes, speech difficulty and right hand clumsiness. The child was described as having been colicky from birth with frequent episodes of prolonged irritability, abdominal cramps and daily vomiting up to the age of three to four years. During the year prior to admission, he began suffering from two to three episodes per week of severe headache, usually lasting one to two hours and often associated with profound pallor, anorexia and lethargy. Typically, they began behind the left eye and progressed to a bifrontal distribution. He was unable to describe the character of his pain. From the Section of Neurology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, 03755. Correspondence and reprint requests to