Hemiplegic migraine

Case contributed by Tim Luijkx
Diagnosis almost certain

Presentation

Headache, vomiting, right eye deviation and left sided weakness.

Patient Data

Age: 8 years
Gender: Male
mri

Asymmetry of cortical veins on the susceptibility weighted sequence, with more prominent veins on the right.

5 punctate foci of supratentorial white matter T2 hyperintensity are evident, none of which demonstrate diffusion restriction.

No intracranial mass lesion. Structurally normal brain.

Case Discussion

The susceptibility findings are consistent with hemiplegic migraine involving the right hemisphere, which accounts for the left sided signs, with no evidence of an acute infarct.

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