Posted at 17:10h
in Case Study
Hemiplegic Migraine: An Unusual Type of Migraine With Aura
By Jonathan Gladstone, M.D.
FRCPC, Gladstone Headache Clinic
Since she was 13, Terri has been experiencing migraine without aura approximately 1-2 times per month. Terri, who is now 21, also gets migraine with visual aura a few times per year and, on several occasions, has experienced migraine with a sensory aura (numbness/tingling up one arm and into her face). However, over the last 18 months, she has had five more dramatic episodes in which she experienced pronounced weakness/paralysis on one side of her body (leg, arm, and face) together with sensory symptoms (numbness/tingling on the same side of the body) and/or visual symptoms (blurriness/loss of vision on one side).
The weakness can last up to 12 hours and has led to Emergency Department visits on each occasion, with co-workers, family members, and Terri herself concerned that she could be suffering a stroke. CT scans and MRIs of her brain have been normal, ruling out a stroke. She was sent for tests of her heart and the blood vessels in her neck as well tests to determine if her blood was prone to form clots. All came back normal.
Terri was eventually referred to a headache specialist. Review of her family history found that her mother and maternal grandmother had similar symptoms, particularly as teenagers and young adults. Their attacks eventually became less frequent and disappeared by menopause. The neurologist was intrigued by this family history and the significant and prolonged attacks of weakness. She wondered about a diagnosis called familial hemiplegic migraine and ordered the newly available genetic tests for this disorder. Interestingly, genetic testing confirmed that Terri did indeed have familial hemiplegic migraine. Terri's unusual events were finally explained and she was placed on a preventive medication in an attempt to decrease the frequency and/or severity of her attacks.