Evaluation of Complicated Migraine in Childhood

Ment, Laura R.; Duncan, Charles C.; Parcells, Patrick R.; Collins, William F.

doi:10.1159/000119953

Cited by 3 publications

(2 citation statements)

References 13 publications

(18 reference statements)

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“…Complete obstruction of the PCA or its branches has been documented angiographicalry in only a few reports of migrainous stroke. 20 " 25 As in the case reported here, revascularization was noted when one patient was restudied. 23 Intraluminal clot within one PCA in the absence of a detectable embolic source, also found in our patient, has been documented previously.…”

Section: • Figure 4 Selective Left Vertebral Angiogram Anteriorpostmentioning

confidence: 62%

Bilateral posterior cerebral artery strokes in a young migraine sufferer.

Moen

Levine

Newman

et al. 1988

Stroke

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We report a young migraine sufferer who developed bilateral posterior cerebral artery territory infarcts during the course of his classic migraines, the second of which was associated with intraluminal clot in the posterior cerebral artery. To our knowledge, bilateral posterior cerebral artery stroke from spontaneous migraine has not been reported. Head computed tomographic, magnetic resonance imaging, and angiographic correlation is presented. The mechanism of migrainous infarction may be in part explained by caliber changes in arterioles and capillaries leading to flow reduction in the more proximal conduit arteries combined with the associated coagulopathy that has been previously documented during migraine attacks. (Stroke 1988; 19:525-528) I schemic cerebral infarction that occurs during the progress of a migraine attack is rare and the mechanisms are uncertain.1 "* Although the neurologic symptoms associated with migraine are most commonfy visual, 7 localized to the cerebral cortex supplied by the posterior cerebral artery (PCA), 8 ischemic strokes attributed to migraine most commonly occur within the territory of the middle cerebral artery. *"11 Only rarely is arterial occlusion demonstrated on angiography and, paradoxically, most often in a single PCA.1 " 312 ' 13 To our knowledge, bilateral PCA stroke from spontaneous migraine has not been reported. We describe a young migraine sufferer with bilateral PCA infarcts, the second of which was associated with an intraluminal clot in the PCA. The angiographic findings in this patient support recently postulated novel mechanisms of migrainous stroke, 14 which we discuss.Case Report A 37-year-old man had suffered from confusional migraine since the age of 20 years. His attacks always began with the acute onset of visual images "shifting" in front of him, associated with scotoma and confusion for the memory of recent events. These symptoms lasted from minutes to hours and were then always followed by a mild to moderate bifrontal throbbing headache, photophobia, and malaise. They generally occurred once to twice a month but recently had increased in frequency, accompanied by a bifrontal headache. However, on one occasion his altered memory and vision did not disappear. Head computed tomography (CT scan) revealed a left temporo-occipital infarct. Catheter vertebral angiography revealed an occluded left PCA (Figure 1). Bilateral carotid angiography was normal. He was placed on aspirin and dipyridamole. One week later he again noted shifting visual images, severe trouble recollecting recent events, and a more diffuse throbbing headache. Medical history was unremarkable for head injury, loss of consciousness, cardiac disease, rheumatic fever, coagulopathy, chiropractic manipulation, dyslipidemia, diabetes mellitus, or hypertension. He had smoked 20 cigarettes/day for 10 years.A sister had suffered from migraines associated with right orbital swelling and blurred vision. A maternal uncle went blind suddenly after a severe headache. The patient's mother also had sev...

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Section: • Figure 4 Selective Left Vertebral Angiogram Anteriorpostmentioning

confidence: 62%

Bilateral posterior cerebral artery strokes in a young migraine sufferer.

Moen

Levine

Newman

et al. 1988

Stroke

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“…Nevertheless these headaches may occur frequently enough to seriously interfere with normal function, and cerebral infarction occasionally complicates pediatric migraine. [1][2][3][4] The management of children with frequent severe or chronic headache suffers from a lack of understanding of the basic mechanisms that should support diagnosis and treatment in these patients.…”

Section: Introductionmentioning

confidence: 99%

Regional Cerebral Blood Flow in Childhood Headache

Roach¹,

Stump²

1989

Headache

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Regional cerebral blood flow (rCBF) was measured in 16 cranial regions in 23 children and adolescents with frequent headaches using the non-invasive Xenon-133 inhalation technique. Blood flow response to 5% carbon dioxide (CO2) was also determined in 21 patients, while response to 50% oxygen was measured in the two patients with hemoglobinopathy. Included were 10 patients with a clinical diagnosis of migraine, 4 with musculoskeletal headaches, and 3 with features of both types. Also studied were 2 patients with primary thrombocythemia, 2 patients with hemoglobinopathy and headaches, 1 patient with polycythemia, and 1 with headaches following trauma. With two exceptions, rCBF determinations were done during an asymptomatic period. Baseline rCBF values tended to be higher in these young patients than in young adults done in our laboratory. Localized reduction in the expected blood flow surge after CO2 inhalation, most often noted posteriorly, was seen in 8 of the 13 vascular headaches, but in none of the musculoskeletal headache group. Both patients with primary thrombocythemia had normal baseline flow values and altered responsiveness to CO2 similar to that seen in migraineurs; thus, the frequently reported headache and transient neurologic signs with primary thrombocythemia are probably not due to microvascular obstruction as previously suggested. These data support the concept of pediatric migraine as a disorder of vasomotor function and also add to our knowledge of normal rCBF values in younger patients. Demonstration of altered vasomotor reactivity to CO2 could prove helpful in children whose headache is atypical.

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Migraña en la infancia

Campos¹

2011

Migraña Y Otras Cefaleas

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Evaluation of Complicated Migraine in Childhood

Cited by 3 publications

References 13 publications

Bilateral posterior cerebral artery strokes in a young migraine sufferer.

Bilateral posterior cerebral artery strokes in a young migraine sufferer.

Regional Cerebral Blood Flow in Childhood Headache

Migraña en la infancia

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