A case of hemiplegic migraine with regional cerebral hypoperfusion and focal cortical diffusion restriction by MRI

A 19-year-old girl presented with acute onset of right-sided weakness and aphasia in the setting of 2 days of severe, unilateral, pulsating headache. Head magnetic resonance imaging (MRI) 4 h after symptom onset showed hypoperfusion of the entire left hemisphere on arterial spin labeling (ASL) images (Fig. 1), with foci of diffusion restriction predominantly involving the left frontal and parietal lobe (Fig. 2), and the magnetic resonance angiography (MRA) images were normal (Fig. 3). Mismatch between ASL and MRA images excluded acute ischaemic stroke approximately. Electroencephalography (EEG) showed profound slow wave activity throughout the left cerebral hemisphere correlating with the distribution of the imaging abnormality. No spontaneous discharges were observed to suggest seizure activity. She gradually improved and was discharged with no neurologic deficits. A follow-up MRI of the head one week later showed normal results. …