<p>Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review</p>

Abstract

Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5–1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.

Detection of Migrainous Infarction with Formal Visual Field Testing: A Case Report

“…Additionally, this case meets criteria for migrainous infarction, although the exact pathophysiology of this case cannot be definitively proven and the etiology of migrainous infarctions at large remains debated. [9][10] Symptoms of posterior circulation strokes can be subtle, go unnoticed by the patient, and result in delayed diagnosis. 1,11 Our patient's presentation was delayed because he did not recognize his symptoms were consistent with a stroke, only becoming suspicious that something was amiss when his usual symptoms failed to resolve.…”

Migrainous Middle Cerebral Artery Infarction With Ipsilateral Hemiparesis

“…Migrainous infarction itself accounts for 0.5-1.5% of all ischemic strokes and does not have a completely understood origin. However, multiple possible mechanisms have been proposed including but not limited to, cortical spreading depression (CSD), biochemical alterations, hemodynamic changes, arterial vasospasm, cerebral edema, and platelet aggregation [ 5 ]. There are, however, multiple risk factors that influence the development of a cerebral infraction including smoking, heart disease, family history, etc.…”

Осложнения Мигрени. Мигренозный Инсульт: Анализ Клинических Случаев

“…Другим возможным механизмом может быть вазоспазм во время мигренозной атаки. Ряд авторов диагностировали вазоспазм у пациентов с мигренозным инсультом с помощью магнитно-резонансной ангиографии или транскраниальной допплерографии [17][18][19][20]. Одним из предполагаемых механизмов вазоспазма может быть выраженная симпатическая активация во время продолжительной сильной боли, результатом чего является артериальная вазоконстрикция и активация коагуляционного каскада, а артерии задней циркуляции особенно чувствительны к симпатической стимуляции [21].…”

“…По литературным данным, на его долю приходится от 0,5 до 1,5 % всех ишемических инсультов [26]. Системный поиск позволил идентифицировать 33 статьи с описанием в целом 119 пациентов (41 мужчины и 78 женщин) [19]. Зрительная аура наблюдалась у 49,6 % пациентов, сенситивная -у 15,1 %, неспецифическая -у 30,3 %, отсутствие ауры -только у 4,2 %.…”