444 - Neurologic recovery following sporadic hemiplegic migraine with aphasia: A Case Report

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

TA

Trevor J. Anesi, BA

Medical Student
Vanderbilt University School of Medicine
Nashville, Tennessee, United States

Co-Author(s)

AJ

Ashwin Jaini, MD

PGY-3
Stanford PM&R Residency Program
Redwood City, California, United States

Corresponding Author(s)

HH

Henry Huie, MD

Vice Chair of Physical Medicine and Rehabilitation and Chief of Brain Injury Rehabilitation
Santa Clara Valley Medical Center
San Jose, California, United States

Case Diagnosis: Sporadic hemiplegic migraine with aphasia

Case Description: A 36-year-old female with a history of migraines developed right hemiparesis with mixed transcortical aphasia 4 weeks following a cesarean delivery. Her initial symptoms were difficulty speaking and significant right-sided weakness including 0/5 strength in the right upper extremity. Her hospital course was significant for seizures and brain MRI showing left hemispheric FLAIR and DWI enhancement. The patient was managed with levetiracetam and lacosamide for seizures, and acetazolamide for hemiplegic migraine prophylaxis. After 10 days, she was admitted to acute rehabilitation with persistent aphasia, 3-4/5 strength in the right arm, and full strength in the right leg. She required moderate assistance for ADLs, transfers, and gait. Following 12-days of inpatient rehabilitation, she achieved 5/5 strength in the right arm and leg. She was discharged at a modified independent level for ADLs and gait, and speech improved to mild to moderate receptive and expressive aphasia.

Discussions: Hemiplegic migraines are a rare disorder characterized by migraine with aura accompanied by unilateral weakness and impairments in vision, speech, or sensation. They are classified as either familial or sporadic, with a prevalence of 0.01% for each subtype. Females are more commonly affected at ratios around 2.5:1 to 4.3:1 respectively, and the average age of onset is 12-17 years old. Hemiplegic migraine attacks present with motor weakness in the aura phase and can last from hours to weeks, but fortunately tend to fully resolve. Our patient was diagnosed with sporadic hemiplegic migraine, and her recovery highlights the positive prognosis for physical and functional improvement during acute rehabilitation.

Conclusions: Hemiplegic migraine is a rare disorder in which weakness and neurologic deficits have potential for recovery. Patients with hemiplegic migraine can benefit from inpatient rehabilitation to fully maximize independence and recovery.