Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: As defined by the International Classification of Headache Disorders, a migrainous infarction(MI) is a migraine with aura whose aura symptoms similar to previous attacks persist for at least an hour in duration along with a corresponding ischemic infarction found in neuroimaging. This is a case of a 62 year-old female who suffered an acute ischemic attack that was later found to be a migrainous infarction. Alexia without agraphia and right hemianopsia as a presentation of the MI is exceedingly rare therefore making this case reportable. There are cases reporting alexia without agraphia that was soon revered following a migrainous aura, but none that persisted for days following.
Case Presentation: The patient is a 62 year old female nurse with well-controlled hyperlipidemia, hypertension, diabetes, and hypothyroidism that presented to the clinic 9 days after an acute ischemic attack in the left posterior cerebral artery (PCA) supplying the left occipitotemporal lobe. The patient presented with a loss of her right-side field of vision and an inability to read words with preserved writing and letter recognition. Nine days prior, the patient experienced a sudden flash of light, followed by migraine symptoms similar to previous episodes. After noticing she was unable to read words, the patient arrived at the ED where she was worked up for a stroke. The CT brain showed evidence of acute ischemia in the left PCA territory, affecting the inferior and medial aspect of the left occipital lobe extending to the posterior medial left temporal lobe. The CT Angiogram showed occlusion of a P3 segment branch of the left PCA. She was admitted to the hospital to identify the nature of the acute ischemic stroke. All studies came back as unremarkable other than a history of a long car ride and clinically insignificant PFO found on transesophageal echo. Treatment recommendations and discussion on various aspects of the case are outlined in this report.
Conclusion: This is the first persisting case of alexia without agraphia in a migrainous infarction patient. There are cases reporting a transient sort of alexia without agraphia following a prolonged migrainous aura, but none persisting for more than a week after the episode. The case presented can expand on the current documented clinical presentations and provide further direction for future research on treatment algorithms and effective prophylaxis regimens.
Academic/Professional Position
Medical Student
Academic/Professional Position (Other)
MS3
Recommended Citation
Gatiganti, Aishwarya; Davila Siliezar, Pamela; Laylani, Noor; and Lee, Andrew G., "Novel Presentation of Migrainous Infarction: Alexia without Agraphia and Right Hemianopsia" (2024). Research Symposium. 5.
https://scholarworks.utrgv.edu/somrs/2023/posters/5
Included in
Novel Presentation of Migrainous Infarction: Alexia without Agraphia and Right Hemianopsia
Background: As defined by the International Classification of Headache Disorders, a migrainous infarction(MI) is a migraine with aura whose aura symptoms similar to previous attacks persist for at least an hour in duration along with a corresponding ischemic infarction found in neuroimaging. This is a case of a 62 year-old female who suffered an acute ischemic attack that was later found to be a migrainous infarction. Alexia without agraphia and right hemianopsia as a presentation of the MI is exceedingly rare therefore making this case reportable. There are cases reporting alexia without agraphia that was soon revered following a migrainous aura, but none that persisted for days following.
Case Presentation: The patient is a 62 year old female nurse with well-controlled hyperlipidemia, hypertension, diabetes, and hypothyroidism that presented to the clinic 9 days after an acute ischemic attack in the left posterior cerebral artery (PCA) supplying the left occipitotemporal lobe. The patient presented with a loss of her right-side field of vision and an inability to read words with preserved writing and letter recognition. Nine days prior, the patient experienced a sudden flash of light, followed by migraine symptoms similar to previous episodes. After noticing she was unable to read words, the patient arrived at the ED where she was worked up for a stroke. The CT brain showed evidence of acute ischemia in the left PCA territory, affecting the inferior and medial aspect of the left occipital lobe extending to the posterior medial left temporal lobe. The CT Angiogram showed occlusion of a P3 segment branch of the left PCA. She was admitted to the hospital to identify the nature of the acute ischemic stroke. All studies came back as unremarkable other than a history of a long car ride and clinically insignificant PFO found on transesophageal echo. Treatment recommendations and discussion on various aspects of the case are outlined in this report.
Conclusion: This is the first persisting case of alexia without agraphia in a migrainous infarction patient. There are cases reporting a transient sort of alexia without agraphia following a prolonged migrainous aura, but none persisting for more than a week after the episode. The case presented can expand on the current documented clinical presentations and provide further direction for future research on treatment algorithms and effective prophylaxis regimens.