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Prolonged Hemiplegic Migraine Led to Persistent Hyperperfusion and Cortical Necrosis: Case Report and Literature

Yacen Hu1,2, Zhiqin Wang1,2, Lin Zhou1,2

  • 1Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, China.

Frontiers in Neurology
|November 15, 2021
PubMed

Insights

This case study shows prolonged hemiplegic migraine attacks can cause permanent brain damage. Patent foramen ovale closure significantly reduced attacks in a patient with hemiplegic migraine.

Area of Science:

  • Neurology
  • Neuroimaging
  • Vascular Neurology

Background:

  • Hemiplegic migraine (HM) is a rare migraine subtype with temporary motor weakness.
  • Permanent deficits and imaging changes are uncommon in HM.

Observation:

  • A patient experienced severe, medication-refractory hemiplegic migraine attacks.
  • Attacks led to irreversible visual impairment and cortical necrosis.
  • Multimodal MRI revealed persistent vasodilation and hyperperfusion during attacks.

Findings:

  • Prolonged HM attacks can cause permanent neurological deficits and cortical necrosis.
  • Persistent hyperperfusion may contribute to prolonged attacks and lasting damage.
  • The patient had a patent foramen ovale (PFO).

Implications:

  • Screening for PFO is recommended in patients with prolonged or intractable HM.
  • PFO closure may reduce HM attack frequency and prevent severe sequelae.
  • This case highlights potential mechanisms and management strategies for severe HM.
Keywords:
cortical necrosishemiplegic migrainehyperperfusionirreversible neurological deficitpatent foramen ovale (PFO)

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