MENINGEAL HYPERPERFUSION VISUALIZED BY MRI IN A PATIENT WITH VISUAL HALLUCINATIONS AND MIGRAINE

A 41-year-old patient with a history of migraine but with no history o f seizures had intermittent prolonged and variable complex visual hall ucinations and illusions lasting 9 days, accompanied by unilateral hea dache. Electroencephalography during these visual symptoms revealed oc cipital epileptic discharges. Distinction between focal migrainous att acks and ictal phenomena was difficult. Magnetic resonance imaging sho wed a lesion in the right visual cortex probably related to low perfus ion and hyperemia of meningeal vessels, representing the rarely descri bed transient MRI changes associated with migraine. Continued treatmen t with antiepileptic drugs and calcium-channel blocking agents complet ely resolved the headache and visual symptoms, while minor EEG changes persisted. After discontinuation of treatment, a second attack occurr ed with a similar and reversible pattern on EEG.