Acta Neurol Belg DOI 10.1007/s13760-015-0444-x
NEURO-IMAGES
Early recurrence of migrainous infarction Dimitri Renard • Elodie Nerrant • Cornelia Freitag
Received: 30 January 2015 / Accepted: 6 February 2015 Ó Belgian Neurological Society 2015
Keywords
Migrainous infarction Migraine Recurrent
A 47-year-old man with a history of migraine with visual aura, without other cardiovascular risk factors, presented with 3 migraine attacks with visual aura during a 11-day period (similar to previous attacks except for longer lasting visual aura, i.e. 85 min) was successfully treated by oral paracetamol. The last episode was followed by persisting visual disturbance. Three days later, brain MRI showed acute left-sided occipital (symptomatic) and subacute cerebellar (asymptomatic) infarctions (Fig. 1). Complete work-up in search of large-artery atherosclerosis, cardioembolism, coagulopathy, angiitis was normal. A diagnosis of recurrent migrainous infarction (MI) was made.
MIs are predominantly located in the posterior circulation territory, mainly in the occipital lobes [1, 2]. Cerebellar involvement has been described in 21 % of MI cases [1]. The exact pathophysiological mechanisms of MI are unclear. In cortical spreading depression, neuronal activation is followed by hypoperfusion. In rare cases, it seems that hypoperfusion is severe enough to cause ischemia leading to infarction. Another hypothesis is that cerebral vasospasms, described to be associated with MI in some reported cases, may lead to brain ischemia [3]. Aura symptoms typically last longer ([ 60 min) in migraine with associated infarction. Early recurrence (based on the imaging characteristics of different brain infarctions on MRI, indicating infarctions at different age) of MI like in our case, however, is uncommon.
D. Renard (&) E. Nerrant Department of Neurology, CHU Nıˆmes, Hoˆpital Caremeau, Place du Pr Debre´, 30029 Nıˆmes Cedex 4, France e-mail: [email protected] C. Freitag Medical Imaging Group (MIG) Nıˆmes, Department of Radiology, CHU Nıˆmes, Hoˆpital Caremeau, France
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Acta Neurol Belg
References 1. Laurell K, Artto V, Bendtsen L, Hagen K, Kallela M, Meyer EL, Putaala J, Tronvik E, Zwart JA, Linde M (2011) Migrainous infarction: a Nordic multicenter study. Eur J Neurol 18:1220–1226 2. Caplan LR (1991) Migraine and vertebrobasilar ischemia. Neurology. 41:55–61 3. Marshall N, Maclaurin WA, Koulouris G (2007) MRA captures vasospasm in fatal migrainous infarction. Headache. 47:280–283
Fig. 1 DWI (A to D) and ADC map (E to H) showing subacute (i.e. hyperintense on DWI [A and B] and isointense on ADC [E and F]) multiterritorial cerebellar and acute (i.e. hyperintense on DWI [C and D] and hypointense on ADC [G and H]) left-sided occipital brain infarctions Conflict of interest
123
We have no conflict of interest to declare.
NEURO-IMAGES
Early recurrence of migrainous infarction Dimitri Renard • Elodie Nerrant • Cornelia Freitag
Received: 30 January 2015 / Accepted: 6 February 2015 Ó Belgian Neurological Society 2015
Keywords
Migrainous infarction Migraine Recurrent
A 47-year-old man with a history of migraine with visual aura, without other cardiovascular risk factors, presented with 3 migraine attacks with visual aura during a 11-day period (similar to previous attacks except for longer lasting visual aura, i.e. 85 min) was successfully treated by oral paracetamol. The last episode was followed by persisting visual disturbance. Three days later, brain MRI showed acute left-sided occipital (symptomatic) and subacute cerebellar (asymptomatic) infarctions (Fig. 1). Complete work-up in search of large-artery atherosclerosis, cardioembolism, coagulopathy, angiitis was normal. A diagnosis of recurrent migrainous infarction (MI) was made.
MIs are predominantly located in the posterior circulation territory, mainly in the occipital lobes [1, 2]. Cerebellar involvement has been described in 21 % of MI cases [1]. The exact pathophysiological mechanisms of MI are unclear. In cortical spreading depression, neuronal activation is followed by hypoperfusion. In rare cases, it seems that hypoperfusion is severe enough to cause ischemia leading to infarction. Another hypothesis is that cerebral vasospasms, described to be associated with MI in some reported cases, may lead to brain ischemia [3]. Aura symptoms typically last longer ([ 60 min) in migraine with associated infarction. Early recurrence (based on the imaging characteristics of different brain infarctions on MRI, indicating infarctions at different age) of MI like in our case, however, is uncommon.
D. Renard (&) E. Nerrant Department of Neurology, CHU Nıˆmes, Hoˆpital Caremeau, Place du Pr Debre´, 30029 Nıˆmes Cedex 4, France e-mail: [email protected] C. Freitag Medical Imaging Group (MIG) Nıˆmes, Department of Radiology, CHU Nıˆmes, Hoˆpital Caremeau, France
123
Acta Neurol Belg
References 1. Laurell K, Artto V, Bendtsen L, Hagen K, Kallela M, Meyer EL, Putaala J, Tronvik E, Zwart JA, Linde M (2011) Migrainous infarction: a Nordic multicenter study. Eur J Neurol 18:1220–1226 2. Caplan LR (1991) Migraine and vertebrobasilar ischemia. Neurology. 41:55–61 3. Marshall N, Maclaurin WA, Koulouris G (2007) MRA captures vasospasm in fatal migrainous infarction. Headache. 47:280–283
Fig. 1 DWI (A to D) and ADC map (E to H) showing subacute (i.e. hyperintense on DWI [A and B] and isointense on ADC [E and F]) multiterritorial cerebellar and acute (i.e. hyperintense on DWI [C and D] and hypointense on ADC [G and H]) left-sided occipital brain infarctions Conflict of interest
123
We have no conflict of interest to declare.
