Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Hemiplegic migraine (HM) is a rare subtype of migraine with both familial and sporadic patterns. These migraines present episodically with reversible attacks of unilateral motor weakness. Patients may experience visual changes, sensory loss, impaired level of consciousness, ataxia, and speech changes. Symptoms can last from hours to days and can mimic acute stroke.
The patient is a 45-year-old male with a past medical history of hypertension and possible cerebral vascular accident use who presents to the emergency department complaining of left extremity numbness and weakness. Neuroimaging showed no acute findings and CT angiogram showed no large vessel occlusion. Tenecteplase was administered and the patient was admitted to the neurologic intensive care unit due to high suspicion of stroke by neurology. On the following day, the patient reports a return to baseline without any neurologic deficits, ataxia, dysarthria, or paresthesia. The patient elaborates that similar episodes occur approximately 10 times a month that are usually milder in intensity. Preceding the episodes, he reports seeing “white speckles'' and experiencing both phono and photosensitivity. The symptoms generally persist for about two hours and resolve spontaneously.
Following current practice guidelines of management of HM, the patient was provided education on migraines. Atorvastatin, lisinopril, and propranolol were prescribed to control his hypertension that can decrease frequency of migraine and prevent ischemic strokes. Triptans are avoided in HM due to the risk of vasoconstriction. Lifestyle management including sleep hygiene, stress reduction, hydration, and avoiding triggers was discussed.
Keywords
Hemiplegic Migraine, Stroke, Male, Aura, Cerebrovascular Accident, Migraine with Aura
Disciplines
Diagnosis | Medicine and Health Sciences | Nervous System Diseases | Neurology | Pathological Conditions, Signs and Symptoms
Document Type
Poster
Included in
Diagnosis Commons, Nervous System Diseases Commons, Neurology Commons, Pathological Conditions, Signs and Symptoms Commons
A Stroke or Not a Stroke? A Case of Chronic Hemiplegic Migraines
Hemiplegic migraine (HM) is a rare subtype of migraine with both familial and sporadic patterns. These migraines present episodically with reversible attacks of unilateral motor weakness. Patients may experience visual changes, sensory loss, impaired level of consciousness, ataxia, and speech changes. Symptoms can last from hours to days and can mimic acute stroke.
The patient is a 45-year-old male with a past medical history of hypertension and possible cerebral vascular accident use who presents to the emergency department complaining of left extremity numbness and weakness. Neuroimaging showed no acute findings and CT angiogram showed no large vessel occlusion. Tenecteplase was administered and the patient was admitted to the neurologic intensive care unit due to high suspicion of stroke by neurology. On the following day, the patient reports a return to baseline without any neurologic deficits, ataxia, dysarthria, or paresthesia. The patient elaborates that similar episodes occur approximately 10 times a month that are usually milder in intensity. Preceding the episodes, he reports seeing “white speckles'' and experiencing both phono and photosensitivity. The symptoms generally persist for about two hours and resolve spontaneously.
Following current practice guidelines of management of HM, the patient was provided education on migraines. Atorvastatin, lisinopril, and propranolol were prescribed to control his hypertension that can decrease frequency of migraine and prevent ischemic strokes. Triptans are avoided in HM due to the risk of vasoconstriction. Lifestyle management including sleep hygiene, stress reduction, hydration, and avoiding triggers was discussed.