Objective:

Migrainous infarct (MI) is a rare condition that accounts for 0.5–1.5% of all ischemic strokes with annual incidence estimated at 0.8 in 100,000 people. Here we highlight a case of occipital MI.

Background:

A 27-year-old woman with history of migraine with aura (MWA) presented for typical but persistent aura symptoms. Her aura symptoms began the day prior to presentation, described as crescentic flashing lights that migrate in bilateral visual fields, followed by her typical migraine headache. Her visual symptoms persisted the following morning, in contrast to her usual duration of 30 minutes, and transitioned to a stable blurring of the right visual field in both eyes. She reported recent reduction in sleep and increased gluten intake, both established migraine triggers for her. Exam revealed a binocular right upper quadrant field cut. After this initial examination, she received sumatriptan. MRI brain with and without contrast revealed an acute left inferomedial occipital lobe infarct. MRV brain was unrevealing and CTA head and neck was without dissection, large vessel occlusion, or focal stenosis. Transthoracic echocardiogram with bubble study and transesophageal echocardiogram were both negative for patent foramen ovale or intra-cardiac shunt. Inpatient cardiac monitoring was normal without documented arrhythmia. Antiphospholipid antibodies were negative, and she does not use exogenous estrogen. As the patient had known MWA, persistent typical aura symptoms, well-localizing acute ischemic stroke, and absence of other convincing etiology despite comprehensive evaluation, this case met International Classification of Headache Disorders-3 Criteria for MI. 

Design/Methods:

NA

Results:

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Conclusions:

MI is a rare disorder that predominantly affects young women with MWA and typically occurs in the posterior circulation. At presentation, it can be difficult to differentiate migraine aura from infarct, and it is imperative to keep this potential diagnosis in mind when determining indication for thrombolytic administration and contraindications to triptans.