Abstract Details

Title Hemispheric Havoc: Migraine’s Asymmetry in Cerebral Blood Flow

Topic Child Neurology and Developmental Neurology

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 8-006

Objective We describe the clinical course, including neuroimaging at multiple time points, of a patient who presented with acute-onset numbness and weakness due to hemiplegic migraine, illustrating perfusion alterations coinciding with symptom changes.

Background Hemiplegic migraine is a subtype of migraine associated with motor weakness. Changes in arterial and venous blood flow in the affected cerebral hemisphere have been noted but are not consistently captured, possibly due to timing of the imaging.

Design/Methods A 17-year-old, right-handed, typically developing and generally healthy female with a remote history of migraine headaches with aura presented with acute-onset numbness preceding severe headache followed by weakness of the right upper extremity, raising concern for acute stroke. Brain MRI obtained in the emergency center approximately 5 hours after onset of numbness revealed decreased left hemispheric perfusion, sparing deeper grey matter structures (thalamus, lentiform nucleus, and subinsular cortex) with left-sided venous engorgement. Repeat neuroimaging was obtained around 18 hours from symptom onset. Second brain MRI revealed resolution of prior hypoperfusion with relatively increased left hemispheric perfusion. MR angiogram of the head and neck were normal. There was gradual symptomatic improvement throughout the hospital course with near complete resolution of symptoms at the time of discharge.

Results This case provides a timeline of perfusion alterations noted on neuroimaging in a patient with evolving hemiplegic migraine.

Conclusions Hemiplegic migraine is a key differential consideration in children presenting with focal neurological symptoms. This case report describes the presentation, clinical course, and neuroimaging findings associated with pediatric hemiplegic migraine.

Authors/Disclosures
Abhijit R. Das, MD (Baylor college of medicine) PRESENTER	Dr. Das has nothing to disclose.
Manasa Sudheendra, MBBS (Texas Children's Hospital/ Baylor College of Medicine)	Dr. Sudheendra has nothing to disclose.
Jeffrey Kuerbitz, PhD (Baylor Child Neurology)	Dr. Kuerbitz has nothing to disclose.
Karla Salazar, MD (Baylor College of Medicine)	Dr. Salazar has nothing to disclose.
Ariel M. Lyons-Warren, MD, PhD (Baylor College of Medicine)	Dr. Lyons-Warren has received personal compensation in the range of $0-$499 for serving as a Consultant for Guidepoint. Dr. Lyons-Warren has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology.

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