Abstract Details

Title Pontine Infarction as a Complication of Basilar-Type Migraine Status Migrainosus

Topic Headache

Presentation(s) P01 - (-)

Poster/Presentation
Number 093

Objective

Background The ICHD-2 defines migrainous infarction as one or more otherwise typical aura symptoms that persist beyond one hour with neuroimaging confirmation of an ischemic infarction in the affected territory. The ICHD-2 criteria exclude patients with new onset aura as well as patients who develop "extra-aural" symptoms at the time of infarction.

Design/Methods Case report from a tertiary medical center.

Results A 42-year-old woman with BTM whose aura symptoms included vertigo, tinnitus, hypacusis, gait unsteadiness, and disorientation developed her typical constellation of aura symptoms followed by a two-week period of status migrainosus, which she was treating with eletriptan 40 to 80mg mg daily. Several days into the headache phase she experienced acute, maximal-at-onset dysarthria and left face, arm, and leg numbness and weakness. These symptoms minimally improved over several weeks, leaving her with mild residual left-sided sensorimotor deficits and dysarthria. She had also been taking estrogen-containing oral contraception. MRI and MRA of the brain revealed a pontine ischemic lesion and basilar artery fenestration.

Conclusions This patient presents a diagnostic dilemma, since her stroke symptoms were not part of her typical aura syndrome and therefore does not fulfill ICHD-2 criteria for migrainous infarction. These restrictions on what constitutes a bona fide migrainous infarction may improve specificity at the expense of sensitivity, potentially underestimating the role of migraine in stroke etiology.

Authors/Disclosures
Matthew S. Robbins, MD, FAAN (Weill Cornell Medicine) PRESENTER	Dr. Robbins has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Robbins has received publishing royalties from a publication relating to health care. Dr. Robbins has a non-compensated relationship as a Board of Directors member, ��ɫ�� Program speaker with American Headache Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Board of Directors member, ��ɫ�� Program speaker with New York State Neurological Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Editorial Board Member with Continuum, ��ɫ�� that is relevant to AAN interests or activities.
Sarah E. Vollbracht, MD (New York-Presbyterian Queens/Weill Cornell)	Dr. Vollbracht has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven Pharmaceuticals. Dr. Vollbracht has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Allergan.
Ilya Kister, MD, FAAN (NYU School of Medicine)	Dr. Kister has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech-Roche. Dr. Kister has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. The institution of Dr. Kister has received research support from Genentech. The institution of Dr. Kister has received research support from Novartis. Dr. Kister has received publishing royalties from a publication relating to health care.
Per Soelberg Sorensen	No disclosure on file

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