Article Text

PDF
072
FEVER, ACUTE HEMIPARESIS, APHASIA, STATUS EPILEPTICUS, PSYCHOSIS… MIGRAINE?
  1. Tom Massey,
  2. Marguerite Hill,
  3. Shaheena Sadiq,
  4. Rachel Smith
  1. Morriston Hospital, Swansea

Abstract

A young female patient, who was otherwise well, presented with acute hemiparesis, dysphasia and confusion after a night out in town. She was febrile and developed focal motor seizures that were difficult to control, culminating in secondary generalisation and status epilepticus. She required intubation and ventilation on ITU. Blood and CSF testing revealed no evidence of infection, drugs, or toxins. MRI brain scans and angiography showed subtle left hemisphere swelling associated with cerebral vasoconstriction, and a degree of cerebellar atrophy. EEG found delta waves over the left hemisphere. After extubation the patient developed delusional and paranoid thoughts about the medical team. All symptoms resolved rapidly after treatment with steroids and three anticonvulsants, and the patient recovered to baseline. The underlying diagnosis proved to be a rare variant of Familial Hemiplegic Migraine type I (CACNA1A I1709T) of which there are two previous reports in the literature, and which seems to have a characteristically severe phenotype.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.