Reversible Paresis of the Left Hand Related to a Migraine Without Aura Attack

Abstract

The comorbidity between migraine and stroke continues to be a debated topic. Prior cases of reversible neuroradiologic lesions have been described in migrainous patients and in particular for those suffering from migraine with aura or complicated migraine attacks. We describe a patient that presented with a migraine without aura (MO) attack followed by paresis of the left hand that resolved completely within 4 days. An early brain magnetic resonance image (MRI) showed congruent cytotoxic-like alteration, whereas the lesion was no longer detectable on a standard 8-day MRI follow-up. A focused high-resolution MRI disclosed a very small cortical lesion, whereas a functional MRI demonstrated normal activation of the previously affected cortex at 8-month follow-up. This MO patient presented with an ischemic-like lesion associated with migraine that reversed completely on MRI examination suggesting that migrainous infarction can occur in MO. Focused high-resolution sequences at follow-up might disclose subtle cortical lesions that could be more frequent than thought, coexisting with the well-known white matter hyperintensities not associated with neurological signs.