Prolonged symptoms in sporadic hemiplegic migraine: aura or migrainous infarction?

PURPOSE: Sporadic hemiplegic migraine is a rare form of migraine associated with motor weakness during the aura phase. While the aura usually lasts less than 1 hour, patients with sporadic hemiplegic migraine frequently have prolonged weakness.

CASE REPORT: A 60-year-old male had sporadic hemiplegic migraine after a head injury at the age of 14. He presented to our emergency department with a typical migraine attack except prolonged right limbs weakness and numbness (>1 day). Brain magnetic resonance imaging showed an acute infarction in the left posterior medial pons. He recovered completely from motor weakness but still complained of residual numbness in his right limbs three months later.

DISCUSSION: We report the first adult case of sporadic hemiplegic migraine with migrainous infarction located in the pons. Since patients with hemiplegic migraine often have prolonged aura, it is easy to be confused with a migrainous infarction. The case report highlights that migrainous infarction is a complication difficult to diagnose and treat early, especially in patients with hemiplegic migraine.