Abstract Details

Title Ictal Vasoconstriction of the Left Middle Cerebral Artery on Magnetic Resonance Angiography in Pediatric Confusional Migraine: A Case Series of Five Patients

Topic Child Neurology/Developmental Neurobiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 098

Objective

Background BACKGROUND: Confusional migraines are a relatively uncommon presentation of migraines in pediatrics. We present five cases of confusional migraine, all of whom had MRI and MRA imaging during the ictal event. All five cases demonstrated vasoconstriction in the L MCA territory. Two of these cases had post-ictal imaging, which demonstrated resolution of the vasoconstriction within 24 hours of the event. A few case reports have demonstrated similar phenomena in the past, but this is the first to document both ictal and post-ictal findings.

Design/Methods DESIGN/METHODS: Case series.

Results RESULTS: Five patients, aged 7-17 years, presented to a tertiary care center with confusional migraines. Symptoms consisted of a headache followed by impaired comprehension, and dysfluent speech as well as amnesia surrounding the event. Two of the five patients also had associated right-sided weakness and paresthesias. On neurological examination, all patients demonstrated varying degrees of impaired comprehension and dysfluent speech, with one of the five patients demonstrating an UMN pattern of weakness of her right side. All five patients received an MRI and MRA during the event, which demonstrated decreased caliber of the left MCA. All patients had resolution of their symptoms in less than twenty-four hours. Two patients received follow-up imaging immediately following the event, which demonstrated resolution of the vasoconstriction.

Conclusions CONCLUSIONS: Our cases demonstrate vasoconstriction in the L MCA territory during a confusional migraine. Vasoconstriction has also been described in some case reports of hemiplegic migraines, lending further credence to the relationship between hemiplegic and confusional migraines. These cases reinforce the role of neurovascular changes in the pathophysiology of migraines.

Authors/Disclosures
Karen A. Spencer, MD, MPH (Boston Children'S Hospital) PRESENTER	Dr. Spencer has nothing to disclose.
Peter Von Wussow	No disclosure on file
Mark L. Schomer, MD (COnnecticut Children'S Medical Center)	No disclosure on file
Anna Minster, MD	No disclosure on file
	No disclosure on file

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