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Prolonged hemiplegic migraine associated with unilateral hyperperfusion on perfusion weighted magnetic resonance imaging
  1. A J Lindahl1,
  2. S Allder1,
  3. D Jefferson1,
  4. S Allder2,
  5. A Moody2,
  6. A Martel2
  1. 1Department of Clinical Neurology, University Hospital, Nottingham, UK
  2. 2Department of Academic Radiology, University Hospital, Nottingham
  1. Correspondence to:
 Dr A J Lindahl, Frenchay Hospital, Bristol BS16 1LE, UK;
 ajlindahl{at}hotmail.com

https://doi.org/10.1136/jnnp.73.2.202

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    Hemiplegic migraine (HM) is an unusual subset of migraine with aura, in which headache is associated with unilateral motor deficits, thought to be attributable to an underlying calcium channelopathy.1 In some cases the neurological dysfunction may outlast the headache and persist for many days. In the initial stages, hemiplegic migraine may mimic cerebral infarction. Within the first few hours after stroke, both computed tomography and magnetic resonance imaging (MRI) are often normal. However, more information can be gained using diffusion (DWI) and perfusion weighted imaging (PWI), which are much more sensitive to acute events in cerebral ischaemia. A recently reported post-processing technique (factor analysis of dynamic studies FADS) can be applied to PWI to generate images representing arterial (“early”) and venous (“late”) contributions to signal intensity.2 This report outlines the findings arising from the application of multimodal MRI techniques to a patient with prolonged hemiplegic migraine.

    Case report

    A 21 year old woman, with a long history of familial HM, presented with a six hour history of headache, nausea, right sided weakness, and expressive dysphasia. Her maternal aunt had also suffered with …

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