Ophthalmoplegic migraine with reversible thalamic ischemia shown by brain SPECT

Two patients who presented with ophthalmoplegic migraine underwent electroencephalography, brain magnetic resonance imaging, cerebral angiography, and technetium Tc 99m ethyl cysteinate dimer single photon emission computed tomography (SPECT) during an attack. Follow-up SPECT was performed after neurologic symptoms resolved. In both patients, SPECT during an attack of ophthalmoplegia and headache demonstrated significantly decreased regional cerebral blood flow (rCBF) in the thalamus on the side of the ophthalmoplegia; rCBF reverted to normal on a follow-up SPECT during the symptom-free period. These findings suggest reversible ischemia in the territories of perforating branches of the posterior cerebral artery may accompany ophthalmoplegic migraine and possibly bear some relationship to the clinical features.