![]() īrain imaging (CT or MRI head) during attacks is usually normal. ![]() īrain imaging like computed tomography (CT) and magnetic resonance imaging (MRI) head, cerebrospinal fluid (CSF) analysis, and electroencephalogram (EEG) may be required to rule out other pathologies, especially if the attacks are new in onset, have prolonged symptoms, and have no family history. Signs and symptoms specific to severe attacks include delusions, somnolence, cerebral edema, seizures, fever, meningismus, cerebrospinal fluid pleocytosis, confusion, agitation, delusions, somnolence, cerebral edema, and cerebral infarction. The headache can be mild to excruciating in intensity, can be bilateral or unilateral, irrespective of the side of aura symptoms, and may manifest either before or during the development of visual symptoms. Reversible hemiplegia can last up to four weeks in rare cases. Motor weakness can vary from mild to severe. However, in turn, or simultaneously, bilateral symptoms have also been reported in one-third of the patients. Motor symptoms usually first appear in the hand and then move centrally to the arms and face. The unilateral symptoms may alternate on the right and left sides between or during attacks. Auras typically manifest in this order: visual, sensory, motor, aphasic, and brainstem symptoms. Two or more auras are almost always evident, each evolving over 20 to 30 minutes and taking hours to resolve. SHM is rarely associated with cerebellar abnormalities. Most patients with FHM1 and others with FHM2 have cerebellar signs like ataxia, dysarthria, and nystagmus. Exam between the attacks is typically normal. Motor and sensory symptoms are typically more prominent in the upper extremities than lower. Ī neurologic exam during an attack may show unilateral hyperreflexia and positive Babinski sign. ![]() The triggers include acute stress, exertion, intense emotions, too little or too much sleep, bright light, and mild head trauma. However, they may reach up to 250 per year in some cases. The attacks may occur with or with triggers. The mean frequency of attacks is three per year. It is essential to rule out other common pathologies that could potentially cause a headache and neurological deficits. A good history of symptoms, potential triggers, family history, and other associated symptoms is essential for diagnosis. The characteristic feature for diagnosis is an episodic, reversible, unilateral motor weakness as migraine aura manifestation, along with at least one other kind of aura. Migraine attacks typically start in the first or second decade of life, with the frequency of attacks decreasing with age.ĭiagnosis of hemiplegic migraine is primarily clinical and can be challenging at times. Seizures independent of hemiplegic migraine attacks have been reported in some patients with FHM, with higher rates in patients with FHM2. Severe attacks rarely cause permanent brain injury, cerebral atrophy, infarction, cognitive decline, and death. The motor symptoms may outlast a headache. Symptoms of a severe attack, including hemiplegia and impaired consciousness, can last for many days to months before they resolve completely. Severe hemiplegic migraine attacks may be associated with encephalopathy or coma. Most patients with hemiplegic migraine have associated headaches. A headache usually occurs during the aura but can occur after the aura symptoms. ![]() The symptoms can last for a few hours to days and rarely can last up to 4 weeks. The symptoms resolve completely in a majority of the cases. The symptoms usually occur over 20 to 30 minutes, although, in rare instances, aura symptoms and motor weakness can develop acutely and mimic a stroke. ![]() Patients may rarely have a bilateral motor weakness either simultaneously or in succession. The unilateral weakness may switch sides between or during attacks. Motor symptoms often start in the hand and gradually spread to the arm and face. Other typical aura symptoms like visual field defects, scotoma, hemianopia, tingling, numbness, ataxia, fever, or lethargy may occur. Motor weakness is, however, not the only type of aura present during the hemiplegic migraine attack. The characteristic feature of hemiplegic migraine is the presence of unilateral motor weakness as aura manifestation in at least a few of the attacks. These individuals may or may not have a family history of migraine with aura. Sporadic Hemiplegic Migraine (SHM) occurs only in an individual without a family history of hemiplegic migraine. FHM4 is diagnosed if no known genetic mutation linked to FHM is identified. ![]()
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