[A case of isolated cerebral angiitis with sequential angiographic changes].

The pathogenesis of migraine has not been completely understood. However, it is generally accepted that the prodromal symptoms encountered in classic migraine usually result from vasoconstriction of intracranial vessels, while the headache itself results from dilation of other cranial vessels, often branches of the external carotid artery. Despite of increasing refinement in angiographic technique, many authors demonstrate the difficulty of interpreting abnormal radiographic findings in patients of migraine. We experienced recently a rare case who complained of migraine with neurological disorder manifesting for dynamic changes of cerebral arteries on sequential angiography. This 39-year-old man was admitted to our hospital with complaint of classic migraine accompanied with transient hemiparesis of the left side. Curious dynamic changes were noted sequentially on the repeated angiograms sequentially during his hospitalization. The carotid angiogram on admission showed narrowing at the right M1 portion. The second angiogram obtained at the fourth hospital day showed reduction of the narrowing, and occlusion of the right angular artery. The patient was treated with Ergotamine. The third angiogram taken after admission for the period of 1 month showed increased stenosis at the right M1 portion. Isolated angiitis of central nervous system was suspected because of such sequential dynamic angiographic changes, and steroid therapy was started. However he began to suffer from hemiparesis of left side one week after the treatment. Therefore, EC-IC bypass was performed, and his symptoms were improved gradually. Migraine is one of the common neurologic disorders countered in clinical practice. This report suggests that careful observation is needed in patients of migraine.