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Sporadic hemiplegic migraine with psychotic episode and MRI abnormalities - therapeutic dilemma: a case report

Hemiplegic migraine (HM) is a rare form of migraine with aura, classified as a complication of migraine in the ICHD 3 classification, which involves transient hemiparesis during the aura. There are two types of HM, sporadic hemiplegic migraine (SHM) with negative family history and familial hemiplegic migraine (FHM) where patient has at least one first- or second- degree relative with the same symptoms. FHM is genetically heterogeneous and dominantly inherited. Three FHM genes(CACNA1A, ATP1A2 and SCN1A) have been identified and some others are under investigation (Russell & Ducros 2011, LaBianca et al. 2015). Attacks of hemiplegic migraine can present with various symptoms, rarely including fever, disturbance of consciousness and psychiatric changes (LaBianca et al. 2015). Differential diagnosis includes vasculitis, encephalitis, stroke, syndromes of mitochondrial encephalomyopathy, lactic acidosis, and stroke- like episodes (MELAS), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL), Creuzfeld-Jakob disease et cetera (Russell & Ducros 2011, LaBianca et al. 2015). Diagnostic exams such as neuroimaging, electroencephalogram (EEG), cerebrospinal fluid (CSF) analysis are needed to exclude other disorders. In some cases there are findings in magnetic resonance imaging (MRI) on T2- weighted and FLAIR images that show cortical swelling and hyperintensity that are most likely caused by brain edema (Russell & Ducros 2011, Bhatia & Babtain 2011, Jacob et al. 2006). Here we report a rare case of sporadic hemiplegic migraine with psychosis and brain edema on MRI.

hemiplegic migraine ; migraine with aura ; psychosis ; brain edema

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