Cortical Laminar Necrosis as a Presenting Manifestation of Migraine in an Apparently Normal Patient: A Rare Case Report

We present a 27-year-old female, a known case of classical migraine headache, who had a severe episode of migraine with visual aura attack which continued late into night. The next morning, she had persistent headache and developed abrupt onset of dysarthria and right hemiparesthesias. She attributed symptoms to her long-lasting headache problem and hence did not seek medical help for the next 2 weeks. The symptoms persisted despite her headache subsiding over the next 36 hours. Her condition worsened 2 weeks later during another such episode of headache. This time she developed right hemiparesis, right hemihypoesthesia, and brief and autolimited left-clonic facial movements. Extensive neurological workup done to rule out other known causes of cerebral infarct with cortical laminar necrosis (CLN) was unrevealing. Magnetic resonance imaging of the brain showed left frontoparietal T2-/T1-/fluid-attenuated inversion recovery hyperintensity without diffusion restriction in diffusion-weighted imaging and subtle blooming in gradient recalled-echo and was radiologically compatible with cortical laminar necrosis. The patient improved with antiplatelets, antimigraine prophylaxis, and stroke rehabilitation therapy. Our present case is a unique one where CLN can be associated with cerebral ischemic infarct due to migrainous etiology.