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Open Access 01-12-2021 | Magnetic Resonance Imaging | Case report

A case report of atypical hemiplegic migraine with nonheadache onset in a Chinese child

Authors: Hui Chen, Xiaolan Sun, Ruiyan Wang, Zhaoshi Yi, Zhixin Huang, Jihua Xie, Xiongying Yu, Yong Chen, Jianmin Zhong

Published in: BMC Neurology | Issue 1/2021

Abstract

Background

Hemiplegic migraine (HM) is an uncommon subtype of migraine with aura including motor weakness. The core symptoms of HM are headache and motor weakness. However, we report a rare case of atypical HM with nonheadache onset in a Chinese child who was misdiagnosed several times.

Case presentation

We report a Chinese boy whose onset was sudden when he was 3 years old. He presented with a variety of phenotypes, including fever, vomiting, alternating hemiplegia, and drowsiness, but no headache in the initial stages. Magnetic resonance imaging (MRI) demonstrated unilateral cerebral oedema during the initial episode of hemiplegia. These symptoms recurred many times. As the disease progressed, the patient developed episodic headache. The patient was misdiagnosed several times with encephalitis, alternating hemiplegia of childhood (AHC) and mitochondrial encephalopathy. Whole-exome next-generation sequencing revealed a de novo heterozygous missense mutation in the ATP1A2 gene(p.Gly715Arg) classified as pathogenic and eventually led to a diagnosis of HM when he was 11 years old. Flunarizine was subsequently administered, and no recurrence was found during follow-up.

Conclusions

HM in children may be atypical in the initial stage of the disease, which could manifest as fever, alternating hemiplegia and drowsiness but no headache at the onset. This could easily lead to misdiagnosis. With age, it may eventually manifest as typical HM. Therefore, attention should be given to differentiation in clinical practice.When similar clinical cases appear, gene detection is particularly important, which is conducive to early diagnosis and treatment.

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Title: A case report of atypical hemiplegic migraine with nonheadache onset in a Chinese child
Authors: Hui Chen
Xiaolan Sun
Ruiyan Wang
Zhaoshi Yi
Zhixin Huang
Jihua Xie
Xiongying Yu
Yong Chen
Jianmin Zhong
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Migraine
Vomiting
Hemiplegia
Aura
Headache
Cerebral Edema
Aphasia
Published in: BMC Neurology / Issue 1/2021
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-021-02302-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A case report of atypical hemiplegic migraine with nonheadache onset in a Chinese child

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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