An uncommon presentation of a migraine headache is hemiplegic migraine, which can clinically imitate other conditions including transient ischemic attacks and stroke with unilateral muscle weakness or hemiplegia. We present a 46-year-old female patient who was admitted with symptoms of a unilateral occipital headache, dysphagia and left-sided motor weakness. Diffusion magnetic resonance imaging (MRI) and brain tomography results were normal. A diagnosis of sporadic hemiplegic migraine was made after extensive workup and managed conservatively with solumedrol. The patient was discharged on prednisone and tetrahydrozoline ophthalmic solution with a drastic improvement in symptoms. On a follow-up visit, there was a complete resolution of symptoms.
The most common manifestations of vertebral artery dissection in approximately 80% of patients are headaches or neck pain. We discuss a case of a 34-year-old patient who presented to the emergency department with altered mental status and nonspecific symptoms. A CT angiogram with intravenous contrast revealed a dissection of the left vertebral artery, and the patient was found to have thromboembolism in the right occipital lobe with ischemia on MRI. This case demonstrates the importance of maintaining a broad differential diagnosis for patients who present with altered mental status and nonspecific symptoms such as headache and neck pain in order to adequately diagnose a potentially fatal condition.
Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous condition that presents with orofacial swelling, facial paralysis, and a fissured tongue. These classic triad of symptoms, however, very rarely present simultaneously. The symptoms are often seen alone or in pairs and appear at any stage in life. Although the etiology of this condition is unknown, various contributing factors have been suggested including infections, immune deficiencies, stress, and genetic predispositions. We present a case of a 23-year-old female patient who has a longstanding history of MRS, anxiety, and depression, and who attempted to overdose on prescription medications due to suicidal ideations.
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