Мигрень с длительной аурой vs мигренозный инсульт: серия клинических случаев

Кулеш А.А., Старикова Н.Л., Демин Д.А., Крапивин С., Мехряков С.А., Кайлева Н.А., Лежикова М.В. Мигрень с длительной аурой vs мигренозный инсульт: серия клинических случаев. Consilium Medicum. 2025;27(2):75–80. DOI: 10.26442/20751753.2025.2.203175

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Kulesh AA, Starikova NL, Demin DA, Krapivin S, Mekhriakov SA, Kaileva NA, Lezhikova MV. Migraine with prolonged aura vs migraine-associated stroke: a case series. Case report. Consilium Medicum. 2025;27(2):75–80. DOI: 10.26442/20751753.2025.2.203175

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Аннотация

В статье приведены три клинических наблюдения пациентов с мигренью с аурой и длительно сохранявшейся очаговой симптоматикой без формирования ишемических очагов. Для сравнения представлен случай мигренозного инсульта. Рассмотренные примеры позволяют сделать заключение, что поступление в стационар пациента с мигренью в анамнезе и очаговым неврологическим дефицитом – сложная клиническая ситуация, требующая индивидуализации диагностической и терапевтической тактики. При наличии длительной ауры принятию обоснованного клинического решения может способствовать проведение перфузионной компьютерной томографии, а также диффузионно-взвешенной магнитно-резонансной томографии. Интерпретация результата последней должна проводиться с осторожностью, вследствие того что транзиторный отек коры может быть ассоциирован с пролонгированием ауры. При невозможности в сжатые сроки надежно дифференцировать мигрень и инсульт следует провести внутривенный тромболизис.

Ключевые слова: мигрень, пролонгированная аура, имитатор инсульта, мигренозный инсульт

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The article presents three clinical cases of patients with migraine with aura and long-term focal symptoms without the formation of ischemic foci. A case of migraine-associated stroke is presented for comparison. The presented cases indicate that admission to the hospital of a patient with a history of migraine and a focal neurological deficit is a challenging clinical situation that requires individualization of diagnostic and therapeutic tactics. In the presence of a prolonged aura, CT perfusion, and diffusion-weighted magnetic resonance imaging, can contribute to an informed clinical decision. The MRI findings should be interpreted cautiously since transient cortical edema may be associated with aura prolongation. If it is impossible to differentiate reliably between migraine and stroke in a short time, intravenous thrombolysis should be performed.

Keywords: migraine, prolonged aura, stroke simulator, migraine stroke

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Список литературы

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20. Farooqi AM, Padilla JM, Monteith TS. Acute Confusional Migraine: Distinct Clinical Entity or Spectrum of Migraine Biology? Brain Sci. 2018;8(2):29. DOI:10.3390/brainsci8020029
21. Старикова Н.Л., Кулеш А.А. Семейная гемиплегическая мигрень. Журнал неврологии и психиатрии. 2021;121(7):114 7 [Starikova NL, Kulesh AA. Familial hemiplegic migraine. S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(7):114-7 (in Russian)]. DOI:10.17116/jnevro2021121071114
22. Iovene V, Piccardi B, Arba F, et al. CT perfusion in acute confusional migraine. Journal of the Neurological Sciences. 2021;429:119319. DOI:10.1016/j.jns.2021.119319
23. Schramm S, Börner C, Reichert M, et al. Perfusion imaging by arterial spin labeling in migraine: A literature review. J Cereb Blood Flow Metab. 2024;44(8):1253-70. DOI:10.1177/0271678X241237733
24. Förster A, Griebe M, Wolf ME, et al. How to identify stroke mimics in patients eligible for intravenous thrombolysis? J Neurol. 2012;259(7):1347-53. DOI:10.1007/s00415-011-6354-93
25. Vroomen PC, Buddingh MK, Luijckx GJ, De Keyser J. The incidence of stroke mimics among stroke department admissions in relation to age group. J Stroke Cerebrovasc Dis. 2008;17(6):m418-22. DOI:10.1016/j.jstrokecerebrovasdis.2008.06.007
26. Terrin A, Toldo G, Ermani M, et al. When migraine mimics stroke: A systematic review. Cephalalgia. 2018;38(14):2068-78. DOI:10.1177/0333102418767999
27. Кулеш А.А., Демин Д.А. Маски инсульта и транзиторной ишемической атаки. Неврология, нейропсихиатрия, психосоматика. 2024;16(6):11-20 [Kulesh AA, Demin DA. Stroke and transient ischemic attack mimickers. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(6):11-20 (in Russian)]. DOI:10.14412/2074-2711-2024-6-11-20
28. Strambo D, Nannoni S, Rebordão L, et al. Computed tomographic perfusion abnormalities in acute migraine with aura: Characteristics and comparison with transient ischemic attack. Eur Stroke J. 2022;7(4):431-8. DOI:10.1177/23969873221114256
29. Thaler AI, Kim BD, Fara MG. Teaching NeuroImages: Magnetic resonance perfusion and diffusion findings in hemiplegic migraine. Neurology. 2020;95(12):554-5. DOI:10.1212/WNL.0000000000010249
30. Hu Y, Wang Z, Zhou L, Sun Q. Prolonged Hemiplegic Migraine Led to Persistent Hyperperfusion and Cortical Necrosis: Case Report and Literature Review. Front Neurol. 2021;12:748034. DOI:10.3389/fneur.2021.748034
31. Belvís R, Ramos R, Villa C, et al. Brain apparent water diffusion coefficient magnetic resonance image during a prolonged visual aura. Headache. 2010;50(6):1045-9. DOI:10.1111/j.1526-4610.2010.01672.x
32. Ali-Ahmed F, Federspiel JJ, Liang L, et al. Intravenous Tissue Plasminogen Activator in Stroke Mimics. Circ Cardiovasc Qual Outcomes. 2019;12(8):e005609. DOI:10.1161/CIRCOUTCOMES.119.005609
33. Cao W, Shen Y, Zhong J, et al. The Patent Foramen Ovale and Migraine: Associated Mechanisms and Perspectives from MRI Evidence. Brain Sci. 2022;12(7):941. DOI:10.3390/brainsci12070941
34. Yan C, Li H, Wang C, et al. Frequency and Size of In Situ Thrombus Within Patent Foramen Ovale. Stroke. 2023;54(5):1205-13. DOI:10.1161/STROKEAHA.122.041524
35. Zhang Y, Wang H, Liu L. Patent Foramen Ovale Closure for Treating Migraine: A Meta-Analysis. J Interv Cardiol. 2022;2022:6456272. DOI:10.1155/2022/6456272
36. Zuo Y, Wang J, Gong Z, et al. Advances in the Study of the Correlation Between Patent Foramen Ovale and Migraine. Psychiatry Clin Psychopharmacol. 2024;34(3):265-71. DOI:10.5152/pcp.2024.23810
37. Yan S, Wang N, Liu H, et al. Patent Foramen Ovale Closure for Migraineurs with Massive Right-to-Left Shunt and White Matter Lesions: An Exploration on Curative Effects. Altern Ther Health Med. 2024;30(11):160-5.
38. Welch KM, Levine SR. Migraine-related stroke in the context of the International Headache Society classification of head pain. Arch Neurol. 1990;47(4):458-62. DOI:10.1001/archneur.1990.00530040114027
39. Arboix A, Massons J, García-Eroles L, et al. Migrainous cerebral infarction in the Sagrat Cor Hospital of Barcelona stroke registry. Cephalalgia. 2003;23(5):389-94. DOI:10.1046/j.1468-2982.2003.00534.x
40. Linetsky E, Leker RR, Ben-Hur T. Headache characteristics in patients after migrainous stroke. Neurology. 2001;57(1):130-2. DOI:10.1212/wnl.57.1.130
41. Hassan M, Belavadi R, Gudigopuram SVR, et al. Migraine and Stroke: In Search of Shared Pathways, Mechanisms, and Risk Factors. Cureus. 2021;13(12):e20202. DOI:10.7759/cureus.20202
42. Vinciguerra L, Cantone M, Lanza G, et al. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res. 2019;12:2941-50. DOI:10.2147/JPR.S209485
43. Batur P, Yao M, Bucklan J, et al. Use of combined hormonal contraception and stroke: A case-control study of the impact of migraine type and estrogen dose on ischemic stroke risk. Headache. 2023;63(6):813-21. DOI:10.1111/head.14473

________________________________________________

1. Awaki E, Takeshima T, Matsumori Y, et al. Impact of Migraine on Daily Life: Results of the Observational survey of the Epidemiology, Treatment, and Care of Migraine (OVERCOME [Japan]) Study. Neurol Ther. 2024;13:165-82. DOI:10.1007/s40120-023-00569-3
2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborations. Global, regional and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602. DOI:10.1016/S0140-6736(16)31678-6
3. Safiri S, Pourfathi H, Eagan A, et al. Global, regional, and national burden of migraine in 204 countries and territories 1990 to 2019. Pain. 2021;163:e293-e309. DOI:10.1097/j.pain.0000000000002275
4. Stovner LJ, Nichols E, Steiner TJ, et al. Global, regional and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:954-76. DOI:10.1016/s1474-4422(18)30322-3
5. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. DOI:10.1177/0333102417738202
6. Tabeeva GR, Katsapava Z. Current concept of the pathophysiology of migraine and new targets for its therapy. Nevrologiya, neiro psikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):143-52 (in Russian). DOI:10.14412/2074-2711-2020-4-143-152
7. Pelzer N, de Boer I, van den Maagdenberg AMJM, Terwindt GM. Neurological and psychiatric comorbidities of migraine: Concepts and future perspectives. Cephalalgia. 2023;43(6):3331024231180564. DOI:10.1177/03331024231180564
8. Viana M, Afridi S. Migraine with prolonged aura: phenotype and treatment. Naunyn-Schmiedeberg's Arch Pharmacol. 2018;391:1-7. DOI:10.1007/s00210-017-1438-4
9. Zayat R, Fermo OP. Two cases of delayed onset, fully reversible cortical oedema and signal intensity on brain MRI without infarction caused by prolonged migraine aura. Neurol Neurochir Pol. 2024;58(2):210-4. DOI:10.5603/pjnns.98031
10. Jicha CJ, Alex A, Herskovitz S, et al. Migraine with prolonged aphasic aura associated with a CACNA1A mutation: A case report and narrative review. Headache. 2023;63(7):975-80. DOI:10.1111/head.14594
11. Lester J, Bustamante JC, García-Moreno C, Klériga E. Atypical perfusion manifestation in migraine with aura. Case Rep Neurol. 2021;13(3):672-6. DOI:10.1159/000519508
12. Viola S, Viola P, Buongarzone MP, et al. Microvascular vasospasm of cerebral cortex in prolonged aura migraine. Neurol Sci. 2018;39(Suppl. 1):95-6. DOI:10.1007/s10072-018-3343-0
13. Scutelnic A, Kreis LA, Beyeler M, et al. Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura. Front Neurol. 2022;13:1004058. DOI:10.3389/fneur.2022.1004058
14. Jacobsen E, Logallo N, Kvistad CE, et al. Characteristics and predictors of stroke mimics in young patients in the norwegian tenecteplase stroke trial (NOR-TEST). BMC Neurol. 2023;23(1):406. DOI:10.1186/s12883-023-03425-x
15. Acarsoy C, Fani L, Al-Hassany L, et al. Migraine and the risk of stroke in a middle-aged and elderly population: A prospective cohort study. Cephalalgia. 2023;43(1). DOI:10.1177/03331024221132008
16. Kurth T, Winter AC, Eliassen AH, et al. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ. 2016;353:i2610. DOI:10.1136/bmj.i2610
17. Jørgensen LK, Mogensen TH. [Herpes simplex encephalitis]. Ugeskr Laeger. 2017;179(2):V07160478.
18. Kulesh AA, Demin DA, Starikova NL, et al. Reversible cerebral vasoconstriction syndrome. Consilium Medicum. 2025;27(2) (in Russian). DOI:10.26442/20751753.2025.2.203150
19. Kulesh AA, Starikova NL, Drobakha VE, et al. The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL): a description of three patients. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):65-72 (in Russian). DOI:10.14412/2074-2711-2020-4-65-72
20. Farooqi AM, Padilla JM, Monteith TS. Acute Confusional Migraine: Distinct Clinical Entity or Spectrum of Migraine Biology? Brain Sci. 2018;8(2):29. DOI:10.3390/brainsci8020029
21. Starikova NL, Kulesh AA. Familial hemiplegic migraine. S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(7):114-7 (in Russian). DOI:10.17116/jnevro2021121071114
22. Iovene V, Piccardi B, Arba F, et al. CT perfusion in acute confusional migraine. Journal of the Neurological Sciences. 2021;429:119319. DOI:10.1016/j.jns.2021.119319
23. Schramm S, Börner C, Reichert M, et al. Perfusion imaging by arterial spin labeling in migraine: A literature review. J Cereb Blood Flow Metab. 2024;44(8):1253-70. DOI:10.1177/0271678X241237733
24. Förster A, Griebe M, Wolf ME, et al. How to identify stroke mimics in patients eligible for intravenous thrombolysis? J Neurol. 2012;259(7):1347-53. DOI:10.1007/s00415-011-6354-93
25. Vroomen PC, Buddingh MK, Luijckx GJ, De Keyser J. The incidence of stroke mimics among stroke department admissions in relation to age group. J Stroke Cerebrovasc Dis. 2008;17(6):m418-22. DOI:10.1016/j.jstrokecerebrovasdis.2008.06.007
26. Terrin A, Toldo G, Ermani M, et al. When migraine mimics stroke: A systematic review. Cephalalgia. 2018;38(14):2068-78. DOI:10.1177/0333102418767999
27. Kulesh AA, Demin DA. Stroke and transient ischemic attack mimickers. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(6):11-20 (in Russian). DOI:10.14412/2074-2711-2024-6-11-20
28. Strambo D, Nannoni S, Rebordão L, et al. Computed tomographic perfusion abnormalities in acute migraine with aura: Characteristics and comparison with transient ischemic attack. Eur Stroke J. 2022;7(4):431-8. DOI:10.1177/23969873221114256
29. Thaler AI, Kim BD, Fara MG. Teaching NeuroImages: Magnetic resonance perfusion and diffusion findings in hemiplegic migraine. Neurology. 2020;95(12):554-5. DOI:10.1212/WNL.0000000000010249
30. Hu Y, Wang Z, Zhou L, Sun Q. Prolonged Hemiplegic Migraine Led to Persistent Hyperperfusion and Cortical Necrosis: Case Report and Literature Review. Front Neurol. 2021;12:748034. DOI:10.3389/fneur.2021.748034
31. Belvís R, Ramos R, Villa C, et al. Brain apparent water diffusion coefficient magnetic resonance image during a prolonged visual aura. Headache. 2010;50(6):1045-9. DOI:10.1111/j.1526-4610.2010.01672.x
32. Ali-Ahmed F, Federspiel JJ, Liang L, et al. Intravenous Tissue Plasminogen Activator in Stroke Mimics. Circ Cardiovasc Qual Outcomes. 2019;12(8):e005609. DOI:10.1161/CIRCOUTCOMES.119.005609
33. Cao W, Shen Y, Zhong J, et al. The Patent Foramen Ovale and Migraine: Associated Mechanisms and Perspectives from MRI Evidence. Brain Sci. 2022;12(7):941. DOI:10.3390/brainsci12070941
34. Yan C, Li H, Wang C, et al. Frequency and Size of In Situ Thrombus Within Patent Foramen Ovale. Stroke. 2023;54(5):1205-13. DOI:10.1161/STROKEAHA.122.041524
35. Zhang Y, Wang H, Liu L. Patent Foramen Ovale Closure for Treating Migraine: A Meta-Analysis. J Interv Cardiol. 2022;2022:6456272. DOI:10.1155/2022/6456272
36. Zuo Y, Wang J, Gong Z, et al. Advances in the Study of the Correlation Between Patent Foramen Ovale and Migraine. Psychiatry Clin Psychopharmacol. 2024;34(3):265-71. DOI:10.5152/pcp.2024.23810
37. Yan S, Wang N, Liu H, et al. Patent Foramen Ovale Closure for Migraineurs with Massive Right-to-Left Shunt and White Matter Lesions: An Exploration on Curative Effects. Altern Ther Health Med. 2024;30(11):160-5.
38. Welch KM, Levine SR. Migraine-related stroke in the context of the International Headache Society classification of head pain. Arch Neurol. 1990;47(4):458-62. DOI:10.1001/archneur.1990.00530040114027
39. Arboix A, Massons J, García-Eroles L, et al. Migrainous cerebral infarction in the Sagrat Cor Hospital of Barcelona stroke registry. Cephalalgia. 2003;23(5):389-94. DOI:10.1046/j.1468-2982.2003.00534.x
40. Linetsky E, Leker RR, Ben-Hur T. Headache characteristics in patients after migrainous stroke. Neurology. 2001;57(1):130-2. DOI:10.1212/wnl.57.1.130
41. Hassan M, Belavadi R, Gudigopuram SVR, et al. Migraine and Stroke: In Search of Shared Pathways, Mechanisms, and Risk Factors. Cureus. 2021;13(12):e20202. DOI:10.7759/cureus.20202
42. Vinciguerra L, Cantone M, Lanza G, et al. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res. 2019;12:2941-50. DOI:10.2147/JPR.S209485
43. Batur P, Yao M, Bucklan J, et al. Use of combined hormonal contraception and stroke: A case-control study of the impact of migraine type and estrogen dose on ischemic stroke risk. Headache. 2023;63(6):813-21. DOI:10.1111/head.14473

Авторы

А.А. Кулеш*^1,2, Н.Л. Старикова¹, Д.А. Демин³, С. Крапивин¹, С.А. Мехряков^1,2, Н.А. Кайлева^1,2, М.В. Лежикова³

¹ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера» Минздрава России, Пермь, Россия;
²ГАУЗ ПК «Городская клиническая больница №4», Пермь, Россия;
³ФГБУ «Федеральный центр сердечно-сосудистой хирургии» Минздрава России, Астрахань, Россия
*aleksey.kulesh@gmail.com

________________________________________________

Aleksey A. Kulesh*^1,2, Natalia L. Starikova¹, Dmitry A. Demin³, Sergey Krapivin¹, Sergei A. Mekhriakov^1,2, Nadezhda A. Kaileva^1,2, Marina V. Lezhikova³

¹Wagner Perm State Medical University, Perm, Russia;
²City Clinical Hospital №4, Perm, Russia;
³Federal Center for Cardiovascular Surgery, Astrakhan, Russia
*aleksey.kulesh@gmail.com

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