Hemiplegic Migraine

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Abstract
A case of migraine exhibiting recurrent episodes of hemiplegia is presented. The attacks lasted from several hours to several days. There were no abnormal neurologic signs between attacks, and accessory clinical studies including carotid arteriogram, electroencephalogram, and spinal fluid examination did not reveal a static intracranial lesion. The hemiplegic attacks could be aborted consistently by the administration of dihydroergotamine. Coincident with the recurrent paralyses, a paroxysmal shoulder-hand syndrome appeared. The case presented was thought to be an example of major hemiplegic migraine. The findings supported a recently suggested sequence of exudation of fluid into the wall and perivascular tissues of an artery of the internal carotid system during the vasodilatitive phase, analagous to the repeatedly demonstrated sequence in the external carotid arterial system. A resulting focal cerebral edema plausibly explains a completely reversible major hemiplegia of several days'' duration. In this patient, shoulder pain and arm and hand edema occurred within minutes of the onset of the paralysis and subsided coincident with its clearing. The patient was well and active up to the moment of the attaks. It is suggested in some instances that centrifugal impulses alone can initiate the shoulder-hand syndrome, the vasomotor factors alone can produce the clinical features of the first stage, that correction of the vasomotor disturbance can halt it promptly, and that "mechanical" factors need participate only in the second and third stages.

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