Abstract Details

Title Migraine with Aura and Stroke Risk in a Young Adult: A Case of Migrainous Infarct”

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-006

Objective N/A

Background While migrainous infarcts are rare, they represent an important, under-recognized, cause of stroke in young adults, especially those with migraine with aura. The diagnostic criteria have been available in the International Classification of Headache Disorders (ICHD) since 1988. Studies have shown that patients with migraine with aura are nearly twice as likely to develop ischemic stroke, especially in young adults without traditional vascular risk factors [1, 2].

Design/Methods N/A

Results We report a case of a 20-year-old man, nonsmoker with a history of migraine with aura since age 14, who presented with a 3-day prolonged headache, atypical for his usual migraine episodes, and bilateral intermittent arm paraesthesia for 3 months. His migraines typically included visual auras, nausea, vomiting, photophobia and phonophobia, but the sensory disturbances, as well as the prolonged duration of headache, were atypical. MRI brain revealed restricted diffusion in the left post-central gyrus and scattered white matter hyperintensities on FLAIR, increased significantly from his baseline MRI from 10 years prior. Lipid panel, urine drug screen and A1c were normal. Vessel imaging, echocardiogram, hypercoagulable work-up and long-term cardiac monitoring were unremarkable. The diagnosis of migrainous infarct was based on both clinical presentation and MRI findings [5, 6]. He was placed on aspirin and advised to avoid triptans, ergotamine derivatives, and NSAIDs.

Conclusions

This case illustrates the importance of early MRI in patients with a new or more severe headache compared to their typical migraine episodes, to differentiate between benign migrainous changes and ischemic events [7, 8]. What makes this case unique is that the patient was a non-smoker, male, and not taking any vasoconstrictive migraine medications which is a departure from the typical risk profile. Additionally, while the patient’s migraine symptoms were atypical for him, there is lack of correlation between his symptoms and the infarct location based on ICHD-3 criteria.

Authors/Disclosures
Golnoush Akhlaghipour, MD PRESENTER	Dr. Akhlaghipour has nothing to disclose.
Gautham V. Upadrasta, MD	Dr. Upadrasta has nothing to disclose.
Johanna Seiden, MD	Dr. Seiden has nothing to disclose.

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