Bilateral persistent ophthalmoplegia in a patient with migraine: persistent migraine aura without infarction?. Issue 4 (7th April 2021)

• Record Type: Journal Article
• Authors: Prakash, Sanjay; Prakash, Anurag; Lodha, Deepali
• Is Part Of: BMJ case reports. Volume 14:Issue 4(2021)
• Publication Date: 2021-04-07
• Subjects: headache (including migraines) -- neuro-opthalmology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-242099
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Migraine auras typically last for 5–60 min. An aura that persists for more than a week without evidence of infarction on neuroimaging is called persistent aura without infarction. Persistent migraine aura without infarction is usually described with visual auras. Herein, we are reporting a 24-year-old man who had an attack of a headache with diplopia, vertigo and tinnitus. Tinnitus and vertigo disappeared within 30 min. The headache also disappeared within 6 hours. However, diplopia and ophthalmoplegia persisted for 4 weeks. Secondary causes of bilateral ophthalmoplegia were ruled out by a proper history, clinical examinations and appropriate investigations. A trial with lamotrigine and sodium valproate led to the complete improvement in ophthalmoplegia within 2 weeks. We considered ophthalmoplegia in this patient as 'persistent brainstem aura without infarction'. We suggest that a possibility of persistent migraine aura without infarction should be considered in all migraineurs who have unexplained and persistent neurological symptoms.