Sporadic hemiplegic migraine

Clinical history: A 17-year-old girl with normal psychomotor development was admitted to our hospital after developing a left hemiparesis that had progressed over 30 minutes and was followed by severe pulsating headache, referred to the right side of the head, with photophobia and drowsiness. One year earlier, a previous episode had occurred, with transitory paresis and paresthesia involving the right side of the face and the right arm, followed by drowsiness, nausea, and vomit. MRI and MR angiography were reported as normal. Family history One cousin had migraine with visual aura. Neurological examination The patient exhibited left hemiparesis and drowsiness, with headache and nausea. Special studies EEG during the attack revealed continuous irregular delta activity over the right hemisphere (Fig. 1). Brain MRI was normal. Follow-up: The patient recovered completely within 24 hours using analgesics. Verapamil therapy was started and no further episodes occurred in the following 2 years. Genetic testing revealed a de novo missense mutation in ATP1A2 gene. Diagnosis: Sporadic hemiplegic migraine.