TY - JOUR
T1 - Vertebral artery dissection presented as lateral medullary syndrome in a patient with migraine
T2 - A case report
AU - Yen, Ju Chun
AU - Chan, Lung
AU - Lai, Yen J.
PY - 2010/12/1
Y1 - 2010/12/1
N2 - Purpose: Migraine and artery dissection are both rare causes of ischemic stroke1. The mechanism of migraine-related intracranial artery dissection is still unknown. It is proposed that the repeated attack of migraine would make the involved artery more vulnerable to tearing and lead to dissection3. Case report: We describe a 42-year-old female suffering from basilar-type migraine for more than 20 years. The patient complained severe dizziness with hyperventilation while watching television. Initially anxiety and migraine attack were impressed in the emergency room, but dizziness accompanied with dysarthria and dysphagia was noted later. After admission, lateral medullary syndrome was suspected after a detailed neurological examination, and a brain magnetic resonance image (MRI) revealed an acute infarction on the left lateral medulla oblongata, confirming the clinical diagnosis Furthermore, cerebral angiography revealed the left distal vertebral artery dissection. The patient was reluctant to use an anticoagulant; therefore aspirin was given for secondary stroke prevention and topiramate for migraine prophylaxis. Conclusion: The exact mechanism of migraine-related intracranial artery dissection has yet to be proven, we propose that this may be caused by vessel wall edematous changes with repeated migraine attacks resulting in sudden or unusual stretching.
AB - Purpose: Migraine and artery dissection are both rare causes of ischemic stroke1. The mechanism of migraine-related intracranial artery dissection is still unknown. It is proposed that the repeated attack of migraine would make the involved artery more vulnerable to tearing and lead to dissection3. Case report: We describe a 42-year-old female suffering from basilar-type migraine for more than 20 years. The patient complained severe dizziness with hyperventilation while watching television. Initially anxiety and migraine attack were impressed in the emergency room, but dizziness accompanied with dysarthria and dysphagia was noted later. After admission, lateral medullary syndrome was suspected after a detailed neurological examination, and a brain magnetic resonance image (MRI) revealed an acute infarction on the left lateral medulla oblongata, confirming the clinical diagnosis Furthermore, cerebral angiography revealed the left distal vertebral artery dissection. The patient was reluctant to use an anticoagulant; therefore aspirin was given for secondary stroke prevention and topiramate for migraine prophylaxis. Conclusion: The exact mechanism of migraine-related intracranial artery dissection has yet to be proven, we propose that this may be caused by vessel wall edematous changes with repeated migraine attacks resulting in sudden or unusual stretching.
KW - Lateral medullary syndrome
KW - Migraine
KW - Topiramate
KW - Vertebral artery dissection
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M3 - Article
C2 - 21210329
AN - SCOPUS:79551716167
VL - 19
SP - 275
EP - 280
JO - Acta Neurologica Taiwanica
JF - Acta Neurologica Taiwanica
SN - 1019-6099
IS - 4
ER -