Pediatric Migraine Aura Status and Cortical Laminar Necrosis: A Clinical Case and a Narrative Review

Migraine aura status is a complication of migraine. It is characterised by the presence of at least 3 episodes of migraine aura within a 3-day period. The pain and/or associated symptoms are often debilitating. Cortical laminar necrosis (CLN) is a gyriform brain lesion caused by insufficient oxygen and glucose supply, resulting in the loss of cortical neurons, often due to cardiac arrest, global hypoxia, and hypoglycaemia. Metabolic disorders, hypoglycaemia, renal and hepatic dysfunction, and immunosuppressive chemotherapy. In children, cortical laminar necrosis has been linked to the subacute or chronic phase of brain damage due to hypoxic-ischaemic encephalopathy. Metabolic disorders, hypoglycaemia, renal and hepatic dysfunction, and immunosuppressive chemotherapy are included as other possible aetiologies. CLN has also been reported in patients with encephalitis, but it is extremely rare in migraine with or without aura.

We describe a 14-year-old boy with no previous neurological problems who was admitted to our unit due to the onset of acute and persistent symptoms characterised by headache, confusion, dysarthria, aphasia and visual disturbances. An initial emergency brain neuroimaging scan revealed edema localised in the supramarginal gyrus of the left cerebral hemisphere, with possible vascular etiology. A control magnetic resonance imaging revealed laminar necrosis of the cortico-pial area located in the same region.

This clinical case is interesting due to the uncommon correlation between cortical laminar necrosis and migraine with aura (MA), the pediatric presentation, the location of hypoperfusion and the atypical progression of the migraine aura. We have reported a narrative review of the two disorders.