Presentation
Known chronic migraine with new onset of left hemiparesis.
Patient Data
Multiparametric contrast-enhanced MRI brain demonstrates periventricular deep white matter high signal intensity foci on T2 and T2 flair imaging. There is no mass effect, no associated abnormal enhancement, and normal diffusion and ADC. SWI is normal with no features to suggest unilateral venous vasodilatation or vasoconstriction.MRI brain is otherwise unremarkable.
Case Discussion
MRI brain demonstrates periventricular deep white matter T2 and T2 flair hyperintensities in this young patient consistent with a known history of chronic migraine. These appear remarkably similar to signal changes that occur in non-specific microvascular ischemia in diabetic and hypertensive patients. In this instance, the patient has no significant contributory past medical history, is non-diabetic, and is non-hypertensive. There is no clinical suspicion to suggest a demyelinating disorder or multiple sclerosis. There was is past documented viral illness.
In view of the left-sided hemiparesis, the SWI is normal with no evidence on imaging to confirm hemiplegic migraine. The patient's symptoms improved on conservative management.
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