Migrainous infarction: a rare and often overlooked diagnosis

Abstract

Migraine is a neurological entity and a well-known independent risk factor for cerebral infarction, which mostly afflicts the young female population. Researching focal neurological signs in this subset of the population with the diagnosis of a neurological ischemic event should always take into account the migraine as the etiology or as an associated factor. The etiology of central nervous system (CNS) ischemia is considerable. Migraine, although rare, also may be included in this vast etiological range, which is called migrainous infarction. In this setting, the diagnostic criteria required for this diagnosis is extensive. Herein, we present the case of a female adolescent who submitted to the emergency facility complaining of diplopia, dysarthria, and imbalance, which started concomitantly with a migrainous crisis with aura—a challenging clinical case that required extensive research to address all possible differential diagnoses.

Bilateral Visual Field Loss in an Adolescent Girl With Migraine Headaches

“…Although migrainous infarction is a reported clinical entity, migraine-related infarction should be considered only after ruling out structural and vascular abnormalities . Because this patient’s infarction was not caused by migraine, calcium channel blockers would not be used.…”

Migrainous infarction

“…Statins and antihypertensives can be used according to current recommendations. No guidelines exist for the use of antithrombotics to reduce stroke risk in patients with migraines 18…”

“…1 Migrainous infarction most frequently takes place in the posterior vasculature of the brain. 3,18 A theory as to why this is the most common distribution affected is attributed to cortical spreading depression, which is known to predominantly occur in the posterior part of the brain. 3,19 Additionally, the most common presenting symptom of a migrainous infarction is visual disturbance, which likely reflects the perfusion changes caused by cortical spreading depression in the occipital cortex.…”

Detection of Migrainous Infarction with Formal Visual Field Testing: A Case Report

“… 1 Migrainous infarctions are a rare complication of migraines, representing only 0.2–0.5% of all ischemic strokes. 6 According to the International Classification of Headache Disorders, migrainous infarction is defined as “One or more migraine aura symptoms occurring in association with an ischemic brain lesion in the appropriate territory demonstrated by neuroimaging, with onset during the course of a typical migraine with aura attack.” 7 The following case demonstrates an unusual presentation of CVA that qualifies as a migrainous infarction. Visual field images demonstrate the diagnostic value of objective optometry evaluation.…”