Repeat Stroke Associated with ‘Migraine with Aura’ and Middle Cerebral Artery Stenosis

Abstract

We present a 21 year-old female, known migraineur, who presented with visual aura followed by throbbing left hemicranial headache, associated with sudden onset of weakness of the right side of the body and moderate to severe pains on the paretic limb (mixed lacuna stroke), three days after the onset of headache. She had a similar episode about 12 months prior to the present ictus. Findings on examination revealed essentially, right spastic hemiparesis with dysaesthesia and subtle right facial paresis. Brain MRI (magnetic resonance imaging) was normal, while MRA (magnetic resonance angiography) revealed middle cerebral artery (M2) stenosis. She was managed with aspirin, propranolol, amitriptyline and physiotherapy on which she made steady progress.