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

Abstract

We report on a 47-year-old white female with a long history of recurrent episodes of migraine with aura, who progressed to develop a continuous intractable headache during the course of which cortical blindness and quadriparesis occurred due to extensive and bilateral hemispheric cerebral infarction. Severe diffuse intracranial major arterial vasospasm was demonstrated by arteriogram. All studies were negative for CNS vasculitis, including cerebral biopsy. The arterial spasm reversed itself, but the patient did not improve. Smoking was the only additional risk factor. Vasospasm is an important cause to be considered in migrainous infarctions. The use of vasoconstrictor agents such as DHE in patients with migraine with prolonged aura has to be carefully re-evaluated.

Susceptibility-weighted Imaging and Magnetic Resonance Angiography during Migraine Attack: A Case Report

“…2,3,6,11 MRA also revealed slight improvement in the vasospasm after the aura phase that persisted in the early headache phase, as reported by Marshall and associates 10 and Sanin's team. 12 In addition, the apparent dilation of the branch of the right PCA was consistent with previous reports of increasing CBF during the headache stage. 2,3,9,11 However, Olesen's group reported a persistent reduction in CBF between the aura and headache phases.…”

Retinal nerve fibre layer thickness measurements using optical coherence tomography in migraine patients

“…Vasospasm has been implicated in migrainous infarction, although documented cases are rare 28 – 30. One can hypothesise that vasoconstrictive substances into the systemic circulation could also cause retrobulbar arteries spasm.…”

Cervical Carotid Artery Vasospasms Causing Cerebral Ischemia

“…V asospasms of the cranial arteries are a well-known cause of cerebral ischemia in cases of subarachnoidal hemorrhage and have also been reported in isolated cases of migraine, 1 vasculitis, 2 and eclampsia. 3 Extracranial vasoconstrictions may arise from mechanical manipulations during operative interventions, 4 vasopuncture, 5 and catheter examinations, 6 as well as in cases of ergot poisoning.…”