A case report of atypical hemiplegic migraine with nonheadache onset in a Chinese child

Abstract

Background Hemiplegic migraine (HM) is an uncommon subtype of migraine with aura including motor weakness. The core symptoms of HM are headache and motor weakness. However, we report a rare case of atypical HM with nonheadache onset in a Chinese child who was misdiagnosed several times. Case presentation We report a Chinese boy whose onset was sudden when he was 3 years old. He presented with a variety of phenotypes, including fever, vomiting, alternating hemiplegia, and drowsiness, but no headache in the initial stages. Magnetic resonance imaging (MRI) demonstrated unilateral cerebral oedema during the initial episode of hemiplegia. These symptoms recurred many times. As the disease progressed, the patient developed episodic headache. The patient was misdiagnosed several times with encephalitis, alternating hemiplegia of childhood (AHC) and mitochondrial encephalopathy. Whole-exome next-generation sequencing revealed a de novo heterozygous missense mutation in the ATP1A2 gene(p.Gly715Arg) classified as pathogenic and eventually led to a diagnosis of HM when he was 11 years old. Flunarizine was subsequently administered, and no recurrence was found during follow-up. Conclusions HM in children may be atypical in the initial stage of the disease, which could manifest as fever, alternating hemiplegia and drowsiness but no headache at the onset. This could easily lead to misdiagnosis. With age, it may eventually manifest as typical HM. Therefore, attention should be given to differentiation in clinical practice.When similar clinical cases appear, gene detection is particularly important, which is conducive to early diagnosis and treatment.

Two pediatric patients with hemiplegic migraine presenting as acute encephalopathy: case reports and a literature review

“…WES was performed by Fujun Genetics Medical Laboratory, Fuzhou, China. The result showed a missense mutation c.2143G>A (p. Gly715Arg) in exon 16 of the ATP1A2 gene (Figure 7) previously reported as a pathogenic mutation (3,4). The same mutations were confirmed in the patient's mother and sister (Figure 7).…”

Unusual Presentation of a Hemiplegic Migraine in a Seven-Year-Old Child: A Case Report

“…However, Ambrosini et al described a 15-year-old child who experienced recurrent episodes that began with an aura of visual symptoms and unilateral paraesthesias lasting less than 15 minutes and were subsequently identified as hemiplegic migraine [ 17 ]. Chen et al described a three-year-old child with a similar presentation to ours who was diagnosed with HM [ 18 ]. Brain imaging scans of most patients are normal.…”