Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of pseudomigraine with pleocytosis

Takashi Nomura, M.D., Yousuke Wakutani, M.D., Koji Doi, M.D., Yasuyo Fukada, M.D., Toshiya Nakano, M.D., Hisanori Kowa, M.D., Takao Takeshima, M.D., Kenji Nakashima, M.D.

Department of Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University

We report a case of pseudomigraine with pleocytosis (PMP) characterized by temporary neurological deficits and elevated cell counts in cerebrospinal fluid (CSF). A 28-year-old woman was admitted to our hospital with a second episode of right side throbbing headache accompanied by hemianopsia without scintillating scotoma of left side, hand numbness and weakness of left hand. Two months before the admission, she experienced a first identical episode, which lasted several hours. On admission to our hospital, neurological examination showed left hemianopsia, mild left hemiparesis, dysesthesia of left hand, exceeded tendon reflex of left upper limb, stiff-neck and positive Kernig's sign. CSF examination showed mild elevation of mononuclear cell counts. No abnormal findings on brain CT and MRI (including diffusion weighted image) were observed. 99mTc-HMPAO single photon emission computed tomography (SPECT) demonstrated extensive hypoperfusion at right cerebral hemisphere, corresponding to her neurological deficits. Her electroencephalography (EEG) showed reduced amplitude on the right occipital area. The reduced amplitude of cortical component of somatosensory evoked potential (SEP) by left median nerve stimulation were observed. On the third day after the admission, her symptoms improved and cell count of CSF was normalized. One week after the onset her SEP, EEG and SPECT were normalized on their retrials. She has never recurred these symptoms. We estblished a diagnosed of psedomigraine with pleocytosis as the first Japanese case.

(CLINICA NEUROL, 42: 954|958, 2002)
key words: paroxismal headache, neurological deficits, CSF pleocytosis, EEG, SPECT

(Received: 11-Sep-02)