Cases reported "Migraine Disorders"

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1/120. Familial hemiplegic migraine with cerebellar ataxia and paroxysmal psychosis.

    Familial hemiplegic migraine is a rare autosomal dominant disorder associated with stereotypic neurologic aura phenomena including hemiparesis. So far two chromosomal loci have been identified. Families linked to the chromosome 19 locus display missense mutations within the CACNL1A4 gene. Here we report on a family with familial hemiplegic migraine and cerebellar ataxia with recurrent episodes of acute paranoid psychosis with anxiety and visual hallucinations associated with migraine attacks. Based on the clinical and haplotype evidence indicating linkage to chromosome 19 in this family, we hypothesize that a dysfunction of the mutated calcium channel may be involved not only in the development of hemiplegic migraine but also in the acute psychotic episodes observed in these patients.
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keywords = visual
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2/120. Prolonged migraine aura without headache arrested by sumatriptan. A case report with further considerations.

    The case of a 42-year-old woman with prolonged migraine visual aura without headache, whose long-lasting episodes of visual aura were successfully controlled by oral sumatriptan, is reported. Effectiveness of sumatriptan was unequivocal, since, after taking sumatriptan, duration of aura would drop from 1.5 h to approximately 20 min. This case suggests that sumatriptan may cross the blood-brain barrier and block spreading depression.
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keywords = visual
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3/120. migraine with aura-like headache associated with moyamoya disease.

    A 49-year-old woman was admitted to our hospital because of severe headache. She had a 10-month history of migraine with aura-like headache that occurred every 7 to 10 days and was preceded by photopsia. Brain CT showed cerebral infarction of the left occipital lobe. Bilateral carotid angiograms showed vascular occlusions in the supraclinoid portion of the bilateral internal carotid arteries with telangiectatic vessels acting as collateral channels to the occluded distal carotid arteries, which were consistent with the diagnosis of moyamoya disease. Headache resolved gradually and has never developed again after the infarct of the left occipital lobe. Pathophysiological mechanisms of migraine-like headache were discussed. We conclude that borderline perfusion of occipital lobe cortex could be a trigger for the development of migraine with aura-like headache in susceptible patients. In the case of atypical attack of migraine detailed investigation should be done to detect underlying vascular diseases such as moyamoya disease.
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keywords = cortex
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4/120. Abnormal visual evoked potentials in children with "Alice in Wonderland" syndrome due to infectious mononucleosis.

    Visual illusions characterized by distortion of form, size, reciprocal position of objects, movement, or color, labeled as "Alice in Wonderland" syndrome, were discussed in children with infectious mononucleosis, as well as in other clinical conditions, such as migraine, epilepsy, use of certain hallucinogenic drugs, etc. The purpose of our study was to investigate for the first time visual evoked potential results in children with "Alice in Wonderland" syndrome associated with infectious mononucleosis. Five children with "Alice in Wonderland" syndrome associated with infectious mononucleosis underwent visual evoked potential studies during and after their clinical symptoms. Visual evoked potential results during the disease demonstrated statistically significant high amplitudes of P100-N145 in all children compared to the control group. A few weeks later, repeated studies after the resolution of the complaints were normal. Since the same findings can be observed in patients with migraine, we postulate that a common pathophysiologic underlying abnormality, which can cause transient focal decreased cerebral perfusion, could be involved in the disease process of these two conditions.
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keywords = visual
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5/120. Unilateral papilloedema after hepatitis b vaccination in a migraine patient. A case report including forensic aspects.

    PURPOSE: To report on a unilateral optic nerve reaction appearing 9-10 hours after vaccination against hepatitis b. methods: To describe the case and discuss the underlying mechanisms. There was a scintillating scotoma leaving a permanent inferior notch in the visual field, but central vision was left normal and with only a slight affection of colour perception. Shortly the optic nervehead appeared engorged, then slightly ischaemic, but was hardly left with evidence of atrophy. RESULTS: Immune-based reactions could hardly be held responsible, multiple sclerosis was unlikely, and ultrasonography excluded optic nervehead drusen. An optic nerve migraine mechanism is probable, possibly with the vaccination having acted as the trigger.
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keywords = visual
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6/120. cluster headache with aura.

    cluster headache with aura is rare. The authors retrospectively reviewed 101 cluster headache patient charts at the Jefferson Headache Center. Six patients had an associated aura, five visual and one olfactory, lasting 5 to 120 minutes. Only one had migraine (without aura). Auras always occurred with or were followed by a severe cluster headache. Two patients were related.
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ranking = 1
keywords = visual
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7/120. migraine with aura and white matter abnormalities: Notch3 mutation.

    The authors report on an Italian family with eight affected members who show autosomal dominant migraine with prolonged visual, sensory, motor, and aphasic aura. These symptoms are associated with white matter abnormalities on brain MRI. All living affected members carry a Notch3 mutation (Arg153Cys) previously reported in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (cadasil). White matter abnormalities occur in a variable percentage of the general migraine population; cadasil should be suspected in migraineurs with prolonged atypical aura and white matter abnormalities.
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ranking = 1
keywords = visual
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8/120. Idiopathic stabbing headache associated with monocular visual loss.

    BACKGROUND: Idiopathic stabbing headache, which is a brief, sharp, severe jabbing pain that is confined to the head, responds well to treatment with indomethacin sodium. It may occur as a primary entity but more likely is associated with other types of headache, including migraine. SETTING: Emergency department of a teaching hospital. PATIENT: A 27-year-old man presented to the emergency department with stabbing, sharp pain in the right temporal area associated with complete of loss vision in his right eye. The patient had a history of migraine with aura since 1995. RESULT: The patient was treated with oxygen inhalation and indomethacin, with complete resolution of his symptoms. CONCLUSION: A case of idiopathic stabbing headache associated with monocular visual loss was relieved by oxygen and indomethacin therapy.
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ranking = 5
keywords = visual
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9/120. The development of cutaneous allodynia during a migraine attack clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine.

    Recently, we showed that most migraine patients exhibit cutaneous allodynia inside and outside their pain-referred areas when examined during a fully developed migraine attack. In this report, we studied the way in which cutaneous allodynia develops by measuring the pain thresholds in the head and forearms bilaterally at several time points during a migraine attack in a 42-year-old male. Prior to the headache, he experienced visual, sensory, motor and speech aura. During the headache, he experienced photo-, phono- and odour-phobia, nausea and vomiting, worsening of the headache by coughing or moving his head, and cutaneous pain when shaving, combing his hair or touching his scalp. Comparisons between his pain thresholds in the absence of migraine and at 1, 2 and 4 h after the onset of migraine revealed the following. (i) After 1 h, mechanical and cold allodynia started to develop in the ipsilateral head but not in any other site. (ii) After 2 h, this allodynia increased on the ipsilateral head and spread to the contralateral head and ipsilateral forearm. (iii) After 4 h, heat allodynia was also detected while mechanical and cold allodynia continued to increase. These clinical observations suggest the following sequence of events along the trigeminovascular pain pathway of this patient. (i) A few minutes after the initial activation of his peripheral nociceptors, they became sensitized; this sensitization can mediate the symptoms of intracranial hypersensitivity. (ii) The barrage of impulses that came from the peripheral nociceptors activated second-order neurons and initiated their sensitization; this sensitization can mediate the development of cutaneous allodynia on the ipsilateral head. (iii) The barrage of impulses that came from the sensitized second-order neurons activated and eventually sensitized third-order neurons; this sensitization can mediate the development of cutaneous allodynia on the contralateral head and ipsilateral forearm at the 2-h point, over 1 h after the appearance of allodynia on the ipsilateral head. This interpretation calls for an early use of anti-migraine drugs that target peripheral nociceptors, before the development of central sensitization. If central sensitization develops, the therapeutic rationale is to suppress it. Because currently available drugs that aim to suppress central sensitization are ineffective, this study stresses the need to develop them for the treatment of migraine.
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ranking = 1
keywords = visual
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10/120. Transitory and permanent visual field defects induced by occipital lobe seizures.

    Visual field defects are rarely associated with epilepsy. We report two patients with a long history of cryptogenetic occipital epilepsy. Both patients suffer complex partial crises accompanied by concentric reduction of the visual field followed, in the first one, by a prolonged left homonymous hemianopsia, and in the second one, by a permanent right inferior quadrantopsia. Occipital and occipito-temporal epileptic activity has been registered between seizures in both patients, and in one patient also during the seizure itself. Differential diagnosis has been considered, especially with migraine.
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ranking = 5
keywords = visual
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