Yet, Another Reason for Secondary Headache.

[jmj11]

This is a first for me, after a 36 + year career in neurology/headache. I have a patient I have followed for years for episodic migraine. Her migraines have been under control. Then, she had an experience a two months ago of confusion, aphasia and syncope. She did not seek medical help, for one reason her spouse is a provider. She feels, in some ways, her mind just has not returned to normal and her headaches have been much worse.

There is a golden rule among headache specialists that if a migraine patient presents with new symptoms, not to blow them off. Everything she described could be accounted for by migraine. However, if a patient who never had headaches in their life, suddenly developed new neurological symptoms or suddenly worsening headaches, they deserve imaging, the same is true for those with a history of migraine.

I was a bit concerned about a TIA or some vascular compromise Vs new migraine aura symptoms (which often can come on after age 60 and she is 60).

The MRI I ordered was very surprising. She had rather large and bilateral, frontal subdural hygromas. Here is a brief description in the literature of non-traumatic, spontaneous hygromas. 

I will not use her MRI scans as I once posted MRI scans here and due to my poor technical skills, I posted it with the patient's id markers. Below is the best image I can find (her's looked worse, especially her sagittal view with severe frontal effacement). I've sent her off to the neurosurgeon and will be back with follow up and maybe her images if I can find a way and have the time to copy it without identifiers.

Mike

 

[EMEDPA]

cool case . thanks!