Abstract text (incl. figure legends and references)
Objective
Spontaneous coronary artery dissection (SCAD) is associated with a history of migraine, though this association is poorly understood. It classically affects young and middle-aged women and is rare in men.(1) SCAD patients with migraine tend to be younger at the time of SCAD. Migrainous infarction is an infrequent, but specific type of ischemic stroke developing during an attack of migraine with aura.(2) We present a case of a migrainous infarction in a man with a history of SCAD a decade earlier.
Background
A 40-year-old man developed episodes of visual aura which was associated with slurred speech and left-sided limb weakness, lasting 3-4 minutes before resolving. A second episode occurred and symptoms persisted for over an hour. A unilateral throbbing headache followed. His medical history was significant for migraine with aura and a spontaneous coronary artery dissection age 29-years. There was a family history of migraine and TIA. He Blood pressure, neurological and cardiac examinations were normal.
Results
Infectious and inflammatory markers were normal, and electrocardiogram showed normal sinus rhythm. CT brain was unremarkable. MRI Brain revealed a small area of diffusion restriction in the right parietal lobe along the postcentral sulcus consistent with an acute infarction. Carotid dopplers, echocardiogram and holter monitor were unrevealing. CT Angiogram found no evidence of vessel abnormality.
Conclusions
Migrainous infarction has not previously been described in a patient with a history of SCAD. This occurred in a male, which is also unusual as both SCAD and migraine predominately affect women.
References
1.Kok SN, Hayes SN, Cutrer FM, Raphael CE, Gulati R, Best PJM, et al. Prevalence and Clinical Factors of Migraine in Patients With Spontaneous Coronary Artery Dissection. J Am Heart Assoc. 2018;7(24):e010140
2.Laurell K, Lundström E. Migrainous infarction: aspects on risk factors and therapy. Curr Pain Headache Rep. 2012;16(3):255-60