Bilateral posterior cerebral artery strokes in a young migraine sufferer

We report a young migraine sufferer who developed bilateral posterior cerebral artery territory infarcts during the course of his classic migraines, the second of which was associated with intraluminal clot in the posterior cerebral artery. To our knowledge, bilateral posterior cerebral artery stroke from spontaneous migraine has not been reported. Head computed tomographic, magnetic resonance imaging, and angiographic correlation is presented. The mechanism of migrainous infarction may be in part explained by caliber changes in arterioles and capillaries leading to flow reduction in the more proximal conduit arteries combined with the associated coagulopathy that has been previously documented during migraine attacks.