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[A case of pseudomigraine with pleocytosis]
Takashi Nomura1, Yousuke Wakutani, Koji Doi
1Department of Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University.
Abstract:
We report a case of pseudomigraine with pleocytosis (PMP) characterized by temporary neurological deficits and elevated cell counts in cerebrospinal fluid (CSF). A 28-year-old woman was admitted to our hospital with a second episode of right side throbbing headache accompanied by hemianopsia without scintillating scotoma of left side, hand numbness and weakness of left hand. Two months before the admission, she experienced a first identical episode, which lasted several hours. On admission to our hospital, neurological examination showed left hemianopsia, mild left hemiparesis, dysesthesia of left hand, exceeded tendon reflex of left upper limb, stiff-neck and positive Kerning's sign. CSF examination showed mild elevation of mononuclear cell counts. No abnormal findings on brain CT and MRI (including diffusion weighted image) were observed. 99mTc-HMPAO single photon emission computed tomography (SPECT) demonstrated extensive hypoperfusion at right cerebral hemisphere, corresponding to her neurological deficits. Her electroencephalography (EEG) showed reduced amplitude on the right occipital area. The reduced amplitude of cortical component of somatosensory evoked potential (SEP) by left median nerve stimulation were observed. On the third day after the admission, her symptoms improved and cell count of CSF was normalized. One week after the onset her SEP, EEG and SPECT were normalized on their retrials. She has never recurred these symptoms. We established a diagnosed of psedomigraine with pleocytosis as the first Japanese case.
Insights
This case study presents pseudomigraine with pleocytosis (PMP), a rare neurological condition. The patient experienced temporary deficits and elevated cerebrospinal fluid (CSF) cells, highlighting PMP
Area of Science:
- Neurology
- Neuroscience
- Clinical Case Reports
Background:
- Pseudomigraine with pleocytosis (PMP) is a rare neurological disorder.
- Characterized by transient neurological deficits and cerebrospinal fluid (CSF) pleocytosis.
- This report details the first documented case in Japan.
Observation:
- A 28-year-old woman presented with recurrent episodes of severe headache, visual disturbances (hemianopsia), and unilateral neurological deficits (hemiparesis, dysesthesia).
- Clinical examination revealed signs of meningeal irritation (stiff-neck, positive Kernig's sign).
- Cerebrospinal fluid analysis showed mild pleocytosis (elevated mononuclear cells).
Findings:
- Brain imaging (CT, MRI) revealed no abnormalities.
- 99mTc-HMPAO SPECT demonstrated significant hypoperfusion in the affected cerebral hemisphere.
- Electroencephalography (EEG) and somatosensory evoked potentials (SEP) indicated dysfunction in the corresponding cortical areas.
Implications:
- PMP should be considered in the differential diagnosis of recurrent neurological deficits and headache with CSF pleocytosis.
- Functional neuroimaging techniques like SPECT are crucial for diagnosing PMP when structural imaging is normal.
- This case underscores the importance of comprehensive neurophysiological assessments for understanding PMP pathophysiology.