Razavi M, Razavi B, Fattal D, Afifi A, Adams H P
Department of Neurology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA.
Arch Neurol. 2000 Sep;57(9):1363-5. doi: 10.1001/archneur.57.9.1363.
It is known that exertion can aggravate migraine headache. However, the relationship between exertion and migraine aura is unknown.
To study the relationship between exertion and migraine aura.
Case report.
Tertiary care hospital.
A 67-year-old man presented with recurrent attacks of exertion-induced hemiplegic migraine. Since the hemiparetic attacks were exertion induced, they were initially ascribed to recurrent transient ischemic attacks. However, the clinical picture, normal findings on cerebral angiography and neuroimaging (during the period of hemiparesis), lack of response to treatment with antiplatelets and anticoagulants, and successful treatment with verapamil suggested that the hemiparesis was not due to ischemia, but was indeed a migraine aura. We suggest that exertion induced the aura of hemiparesis by lowering the threshold for the development of cortical spreading depression. Even though our patient had no family history of hemiplegic migraine, a mutation in an ion channel gene (eg, the CACNA1A gene on chromosome 19) might account for his episodic attacks.
Migraine aura should be included in the differential diagnosis of exertion-induced focal neurologic deficit.
已知运动可加重偏头痛。然而，运动与偏头痛先兆之间的关系尚不清楚。
研究运动与偏头痛先兆之间的关系。
病例报告。
三级医疗医院。
一名67岁男性，出现反复发作的运动诱发偏瘫性偏头痛。由于偏瘫发作是由运动诱发的，最初被归因于复发性短暂性脑缺血发作。然而，临床表现、脑血管造影和神经影像学检查（偏瘫期间）结果正常、对抗血小板和抗凝治疗无反应以及维拉帕米治疗成功提示偏瘫并非由缺血引起，而是确实为偏头痛先兆。我们认为运动通过降低皮质扩散性抑制发生的阈值诱发了偏瘫先兆。尽管我们的患者无偏瘫性偏头痛家族史，但离子通道基因（如19号染色体上的CACNA1A基因）突变可能是其发作性发作的原因。
偏头痛先兆应纳入运动诱发局灶性神经功能缺损的鉴别诊断。
