Hemiplegic migraine in childhood: Diagnostic and therapeutic aspects

Evidence for a separate type of migraine with aura

“…21 Metabolic abnormalities associated with focal deficits (i.e., hypercapnia, hyponatremia, hypocalcemia, hepatic failure, and renal failure), meningitis/encephalitis, 22 carotid dissection, 23 antiphospholipid syndrome, 24 systemic lupus erythematosus, 25 and ornithine transcarbamylase deficiency 26 should also be considered as differential diagnoses together with other reported conditions that mimic SHM. 11,[27][28][29][30] Inherited disorders associated with migraine headache that may include hemiparesis are cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy 31 ; mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes 32 ; hereditary hemorrhagic telangiectasia, 33 a 35 ; and benign familial infantile convulsions. 36 Because the description of socalled migraine symptoms in persons with these other syndromes is limited, it is unknown if their migraine symptoms fulfill the diagnostic criteria for SHM or FHM proposed by us.…”

Stroke in childhood

“…Magnetic resonance imaging (MRI) is more sensitive than computed tomography (CT) for the diagnosis of infarction within 24 hours, and is comparable for the diagnosis of haemorrhage 2. It is now clear that, although most patients with prolonged clinical deficits eventually have infarction on neuroimaging, similar but clinically and radiologically reversible syndromes may occur—for example, in severe hemiplegic migraine; contralateral electroencephalogram (EEG) slowing and a scan showing oedema without infarction are clues to the diagnosis 3. On the other hand, patients with short lasting neurological syndromes or even with no clinical symptoms at all may have suffered infarction, sometimes quite extensive—for example, in sickle cell disease 4.…”

Hemiplejik migren: Bir olgu sunumu

“…Çocuk migren hastalar›nda bafl a¤r›s› ata¤›na efllik eden fokal nörolojik bulgular özellikle de hemipleji tablosu olabilir (1). Hemiplejik migren tan›s›, migren ata¤› s›ras›nda tek tarafl› güçsüzlü¤ün olmas› ile konulur.…”

“…Hemiplejik migrende, akut nörolojik bozuklu¤un düzelmesi, EEG'de akut dönem-de fokal yavafllaman›n olmas›, öyküsünde tekrar edici ataklar›n olmas›, aile öyküsünün varl›¤› tan› ölçütlerindendir. E¤er klinik durum tipik ise akut tabloda beyin anjiyografisi yap›lmas›na gerek yoktur (1). Ailesel hemiplejik migren otozomal bask›n (dominan) geçifllidir, ataklar erken çocukluk, ergen ya da erken eriflkin dönemde bafllar.…”