Hemiplegic migraine with prolonged aura: case report
Abstract
Hemiplegic migraine (HM) is a rare subtype of migraine with aura, characterized by transient motor weakness and neurological symptoms such as visual, sensory, or speech disturbances. The typical aura duration is 20 to 60 minutes, but in prolonged cases, it may mimic ischemic attacks, requiring careful differential diagnosis. We report the case of a 30-year-old woman with a history of sporadic HM and essential tremor, using topiramate and propranolol, who experienced her first episode of prolonged aura during a Covid-19 infection. On 02/04/25, she developed a severe pulsating headache with photophobia, phonophobia, nausea, and vomiting. Eight hours after the onset of pain, she presented right-sided hemiparesis (grade IV), global aphasia, and fever (37.8°C), without sensory deficits. Tests (head CT, CT angiography, brain MRI, and CSF analysis) were normal. COVID-19 was confirmed by swab, with mild flu-like symptoms. Treatment with magnesium sulfate, sodium valproate, acetazolamide, and chlorpromazine was initiated, with complete resolution after 72 hours. Most patients experience full resolution of aura symptoms, even when prolonged. The frequency and severity of attacks tend to decrease after age 50, often evolving into typical migraine without motor symptoms. In severe cases, particularly with early onset, permanent neurological deficits may occur. The risk of migrainous infarction is rare but possible, necessitating differentiation from stroke. Migraine with aura increases…
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