Evidence of vascular compromise over the visual cortex during migrainous headache: a case report with MRI study

The objective of the present study was to demonstrate MRI evidence of vascular compromise as seen in a 17-year-old female presenting with migrainous headache. The patient had been experiencing migrainous headache 2 days ago. She had visual auras lasting for a few hours before the attack. Upon meeting with her physician she indicated symptoms of left sided numbness during the headache. No neurological deficit was detected when the first MRI was performed, and all of her symptoms resolved within 4 days of the attack. The MRI study showed a focal area of restricted diffusion at the right visual cortex. A short segment of vascular enhancement was noted on the surface of the affected gyrus. MRS showed a normal N-acetyl aspartate, choline, and creatine with no elevation of lactate. A follow-up MRI study 5 months later showed normal finding with no residual lesion. The authors concluded that the abnormality on the first MRI was the ischemic insult of the ictal visual cortex which was transient during the migraine attack. The pathophysiology was more likely from reversible focal venous congestion.