[Basilar artery migraine with transient MRI and EEG abnormalities]

We report a case of basilar artery migraine with transient MRI and EEG abnormalities. A 25-year-old male medical student developed a right occipital throbbing headache one hour after the abrupt onset of vertigo, nausea, left-sided homonymous hemianopsia and nystagmus. All of his complaints subsided the following day. He had suffered from attacks of headache accompanied by the same type of aural symptoms almost every ten days. He was therefore diagnosed as having basilar artery migraine. CT scans during the period of recurrent migraine demonstrated no abnormalities, while T2-weighted MR images revealed a high signal intensity region in the right occipital cortex and adjacent white matter perfused by rami temporales of the right posterior cerebral artery. Cerebral hypoperfusion was detected by a SPECT scanner in the right posterior region, where EEG recorded during the migraine attack demonstrated paroxysmal-localized sharp waves. MRI and EEG performed two months after the last attack showed no obvious abnormalities along with clinical disappearance of the migraine attacks. We found few reports of transient MRI changes associated with migraine. This case suggests that transient changes in MR images reflect vasogenic edema caused by migraine.