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[Recurrent hemispheric symptoms without proof of ischemia]
F Hammersen1, N Lübcke, S Lüders
1Abteilung für Innere Medizin, St.-Josefs-Hospital Cloppenburg. f.hammersen@info-gmbh.org
Deutsche Medizinische Wochenschrift (1946)
|November 13, 2004
Summary
Recurrent neurological symptoms in patients with cardiovascular risk factors may be misdiagnosed as transient ischemic attacks. This case highlights that migraine with aura, specifically sporadic hemiplegic migraine, should be considered in the differential diagnosis.
Area of Science:
- Neurology
- Cardiology
Background:
- A 48-year-old patient presented with recurrent neurological deficits mimicking transient ischemic episodes over six years.
- The patient had a significant cardiovascular risk profile, contributing to the initial diagnosis.
Observation:
- Neurological symptoms were associated with frequent headaches.
- Extensive diagnostic workup including neuroimaging, vascular ultrasound, echocardiography, EEG, and 24-hour ECG showed no abnormalities.
- Blood tests revealed hypercholesterolemia and hypertriglyceridemia; polysomnography identified moderate upper airway resistance syndrome.
Findings:
- The patient was diagnosed with migraine with aura, specifically sporadic hemiplegic migraine.
- Treatment with aspirin, rizatriptan, metoprolol, and acetazolamide resulted in complete resolution of symptoms and no recurrence during follow-up.
Implications:
- Recurrent neurological deficits in patients with cardiovascular risk factors can be misdiagnosed as cerebral ischemia.
- Migraine with aura should be considered in the differential diagnosis of transient neurological symptoms, even in the presence of cardiovascular risk factors.