Hemiplegic Migraine During Pregnancy: Unusual Magnetic Resonance Appearance With SPECT Scan Correlation

OBJECTIVE: This article discusses the pathophysiology and implications for treatment of hemiplegic migraine within a case study presentation. BACKGROUND: We evaluated a 31-year-old white woman for hemiplegia in her 36th week of pregnancy. She initially presented with severe headache, dysarthria, lethargy, and left-sided numbness and weakness. Hemiplegic migraine remains a diagnosis made by exclusion; neurologic examination of these patients is localizing, but nonspecific. DESIGN: Magnetic resonance imaging and single photon emission computed tomography scanning were performed on this patient during an exacerbation of headache associated with dense hemiplegia. RESULTS: Magnetic resonance imaging showed a superficial cerebral hemispheric signal abnormality with enhancement. Single photon emission computed tomography scanning confirmed hyperperfusion of that hemisphere. CONCLUSIONS: We believe the imaging evidence in our patient suggests that hemiplegia was caused and sustained by hyperperfusion. This case lends supportive evidence to a primarily vasodilatory mechanism and hyperperfusion as an etiology of the paralysis in such headaches and perhaps migraine with aura.