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Meningeal hyperperfusion visualized by MRI in a patient with visual hallucinations and migraine
Abstract:
A 41-year-old patient with a history of migraine but with no history of seizures had intermittent prolonged and variable complex visual hallucinations and illusions lasting 9 days, accompanied by unilateral headache. Electroencephalography during these visual symptoms revealed occipital epileptic discharges. Distinction between focal migrainous attacks and ictal phenomena was difficult. Magnetic resonance imaging showed a lesion in the right visual cortex probably related to low perfusion and hyperemia of meningeal vessels, representing the rarely described transient MRI changes associated with migraine. Continued treatment with antiepileptic drugs and calcium-channel blocking agents completely resolved the headache and visual symptoms, while minor EEG changes persisted. After discontinuation of treatment, a second attack occurred with a similar and reversible pattern on EEG.
Insights
This study details a rare case of prolonged visual disturbances mimicking migraine aura, later confirmed as occipital epileptic discharges. Effective treatment involved antiepileptic and calcium-channel blocking drugs.
Area of Science:
- Neurology
- Epileptology
- Neuroimaging
Background:
- Migraine with aura can present with complex visual disturbances.
- Differentiating migraine aura from epileptic seizures can be challenging.
Observation:
- A 41-year-old patient experienced 9 days of prolonged visual hallucinations and unilateral headache.
- Electroencephalography (EEG) revealed occipital epileptic discharges during visual symptoms.
- Magnetic Resonance Imaging (MRI) showed transient changes in the right visual cortex.
Findings:
- The patient's symptoms were initially difficult to distinguish from focal migrainous attacks.
- Transient MRI changes, possibly due to perfusion abnormalities, were observed.
- Treatment with antiepileptic drugs and calcium-channel blockers resolved headache and visual symptoms.
- EEG abnormalities persisted mildly after symptom resolution and recurred upon treatment discontinuation.
Implications:
- This case highlights the overlap between migraine aura and epileptic phenomena.
- Transient MRI changes can be associated with migraine.
- Combined antiepileptic and calcium-channel blocker therapy may be effective for such presentations.
- Further research is needed to understand the relationship between migraine and epilepsy.