Dysmetropsia and Cotard's syndrome due to migrainous infarction – or not?

Abstract

Migrainous infarction accounts for 12.8% of ischemic strokes of unusual etiology. A 59-year-old woman with longstanding migraine with aura experienced what appeared to be migrainous infarction characterized by dysmetropsia and transient Cotard's syndrome. Imaging demonstrated right temporal-parietal-occipital changes with apparent cortical laminar necrosis. The spectrum of the pathophysiology of migrainous infarction has not been established; however, cortical spreading depression may explain the appearance of imaging findings that do not obey a vascular territory.