Presentation
PH of migraine. 2 weeks of recurrent severe headache now with perisistent lower limb weakness and numbness (left greater than right). No ilicit drug use. Not pregnant.
Patient Data
Multiple sites of restricted diffusion especially in the right hemisphere (confirmed on ADC) associated with mutiple sites of arterial luminal narrowing especially on the right but also the left (anterior and posterior circulation).
Complete resolution of vascular narrowing. Residual gliosis and atrophy at sites of previous infarction.
Case Discussion
This case is typical of reversible vasoconstriction ie a young woman with thunderclap headache and neurological deficit (in this case causing infarction). No subarachnoid hemorrhage. Spontaneous resolution of vasoconstriction over time thus not due to established angiitis. No specific precipiating features such as illicit drug use ie cocaine and metamphetamine.
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