Bilateral Occipital Lobe Infarction in Acute Migraine: Clinical, Neurophysiological, and Neuroradiological Study.

Abstract

A woman having common migraine attacks coincident with an asymmetrical bilateral occipital lobe infarction that spared the brainstem and cerebellum underwent these studies: serial electroencephalography, brainstem auditory, visual and somatosensory evoked potentials, magnetic resonance imaging of the brain and cerebral arteriography. The patient's vision improved greatly during a one-year follow-up. The absence of risk factors for stroke suggested that migraine caused the infarction in the posterior circulation network. The pathophysiological mechanisms of stroke in migraine remains speculative.

Severe Diffuse Intracranial Vasospasm as a Cause of Extensive Migrainous Cerebral Infarction

“…Our patient was receiving dihydroergotamine intravenously at the time she developed cerebral infarction. A similar case was reported by Ganji et al (21). Ergotamine compounds cause vasospasm (22,23), but it is usually generalized and mostly affects the medium-sized muscular arteries of the extremities.…”

The Cerebellum and Migraine

“…Circulatory changes and episodes of stroke putatively related to basilar‐type migraine have been reported 54 . Such infarcts have also been reported in the thalamus 55 and the occipital areas 56–58 . Knowing the genetic mechanisms behind certain forms of migraine, scrutiny indicates that many migraine patients previously described according to their clinical pictures as “cerebellar migraine” or “basilar migraine,” probably carried one of the known ion channel related mutations.…”

“…54 Such infarcts have also been reported in the thalamus 55 and the occipital areas. [56][57][58] Knowing the genetic mechanisms behind certain forms of migraine, scrutiny indicates that many migraine patients previously described according to their clinical pictures as "cerebellar migraine" or "basilar migraine," probably carried one of the known ion channel related mutations. A mutation at the FHM2 locus at the ATP1A2 gene has been described in familial BTM without hemiplegia, suggesting a connection between BTM and hemiplegic migraine.…”