Paroxysmal hemicrania masquerading as a stroke in an elderly gentleman: case report

Abstract

Background Paroxysmal hemicrania has not been associated with ipsilateral weakness, loss of sensation and Horner’s syndrome. This report is the first of its kind documented in literature. Case presentation This was an elderly, sixty-five-year-old Chinese male who presented with a headache fulfilling criteria of paroxysmal hemicrania and was found to have signs of ipsilateral conjunctival injection, Horner’s syndrome, weakness and loss of sensation; with resolution of the patient’s physical signs after relief of the headache. Brain magnetic resonance imaging did not show any strokes or other headache mimics. The patient had a marked response to indomethacin and a decrease of headache intensity and frequency with indomethacin prophylaxis. Conclusions Paroxysmal hemicrania has joined the list of stroke chameleons and that it would be one of the differentials in a patient with hemiplegia, hemisensory loss, autonomic signs and severe headache. It suggests that paroxysmal hemicrania in the elderly present atypically.