Paroxysmal hemicrania masquerading as a stroke in an elderly gentleman: case report
Boon Hian Tan1, Astrid Melani Suantio2, Yeow Hoay Koh3
1Department of General Medicine, Geriatric Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore. boonhian.tan@mohh.com.sg.
Background:
Paroxysmal hemicrania has not been associated with ipsilateral weakness, loss of sensation and Horner's syndrome. This report is the first of its kind documented in literature.
Case Presentation:
This was an elderly, sixty-five-year-old Chinese male who presented with a headache fulfilling criteria of paroxysmal hemicrania and was found to have signs of ipsilateral conjunctival injection, Horner's syndrome, weakness and loss of sensation; with resolution of the patient's physical signs after relief of the headache. Brain magnetic resonance imaging did not show any strokes or other headache mimics. The patient had a marked response to indomethacin and a decrease of headache intensity and frequency with indomethacin prophylaxis.
Conclusions:
Paroxysmal hemicrania has joined the list of stroke chameleons and that it would be one of the differentials in a patient with hemiplegia, hemisensory loss, autonomic signs and severe headache. It suggests that paroxysmal hemicrania in the elderly present atypically.
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