Cortical laminar necrosis in a case of migrainous cerebral infarction

We report a 27-year-old woman, a known case of classical migraine headache, on oral contraceptive pills. She had a severe episode of migraine with visual aura attack, which continued late into the night. The next early morning, her headache persisted and she developed abrupt onset of dysarthria, right hemiparaesthesias. She attributed symptoms to her long-standing headache problem, and hence did not seek medical help for the next two weeks. The symptoms persisted despite her headache subsiding over the next 24 hours. She worsened 2 weeks later during another such episode of headache. This time, she developed right hemiparesis. The patient was admitted with provisional diagnosis of stroke. MRI of the brain showed left temporoparietal lesion and was radiologically compatible with cortical laminar necrosis.Extensive work-up was done to rule out other causes of young stroke. The patient improved with antiplatelets, antimigraine prophylaxis and stroke rehabilitation therapy.