| |
|
| This news site is not sanctioned by, nor part of, the Diamond Headache Foundation, The American Academy of Neurology OR The American Headache Society. |
| News covering selected sessions related to migraine from 2008 medical conferences. |
| Annual Meeting of the American Academy of Neurology |
Chicago, IL April 15-18, 2008 |
|
|
|
| |
Migraine with Acute Confusion May Be
Early Clue to CADASIL |
|
|
BY DON SCHRADER
Contributing Writer |
CHICAGO
(ECCC)— Migraine that is associated with an acute
confusional state may represent a clue that allows earlier
diagnosis of patients with cerebral autosomal dominant
arteriopathy with subcortical infarcts and leukoencephalopathy
(CADASIL), reported Dr. Edgar T. De Peralta on April 17 during
the annual meeting of the American Academy of Neurology.
Seven of 11 CADASIL patients with migraine had concomitant
confusion within 3 years of migraine onset, said Dr. De Peralta
of New York University. The severity of the episodes intensified
over time but improved dramatically after a patient had a first
stroke.
“To our knowledge, this is the first description of acute
confusional episodes associated with migraine in CADASIL
patients,” Dr. De Peralta and colleagues concluded. “These
events precede onset of stroke, at which time CADASIL is
typically diagnosed, but almost two decades. CADASIL is a rare
condition, but it should be suspected in cases of migraine
associated with acute confusional state.”
About 30% of CADASIL patients have migraine, but development of
acute confusional state had not been reported. The researchers
evaluated 20 CADASIL patients, 14 of whom reported headache.
Eleven of the 14 met diagnostic criteria for migraine. Eleven of
the patients also reported visual, sensory, or speech aura.
Eight had atypical migraine.
Seven of the patients experienced concomitant confusion within 3
years of the start of their migraines. Altered mental status
occurred at the onset of aura or headache, either abruptly or
insidiously. The episodes lasted 2 to 48 hours and usually ended
abruptly. Characteristics of the acute confusional state
included disorientation to time and place, inability to
recognize friends and relatives, difficulty finding the way
home, and agitation.
Patients recognized the confusional episodes as distinct, and
they felt the need to seek a safe place for protection. Six
patients had either partial or complete inability to recall the
episode and associated events.
Acute confusional migraine preceded CADASIL diagnosis by almost
20 years.
“Better understanding of the pathophysiology of CADASIL might
provide a unifying explanation for the overlap among migraine,
acute confusional migraine, transient global amnesia, and
CADASIL,” Dr. De Peralta concluded. “Acute confusional migraine
in adults appears to be unique to CADASIL and may be a
presenting feature that may allow us to recognize it earlier
than we do now. Brain MRI and/or Notch 3 sequencing [for
mutations associated with CADASIL] should be considered in
patients with ACM.” |
| Copyright 2008 Elsevier Custom Conference Coverage. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, through negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, the Publisher recommends that independent verification of diagnoses and drug dosages should be made. Opinions expressed in this publication are those of the original authors and do not necessarily reflect those of the Publisher, the sponsor, or the editors. Elsevier assumes no liability for any material published herein. |
|
|
|
