ACUTE CONFUSIONAL MIGRAINE AND MIGRAINOUS INFARCTION IN CHILDHOOD

We report two children with acute confusional migraine (ACM) and anoth er with migrainous infarction (MI), aged 7-12 years. There was a famil y history of migraine in all patients. The patients, who were all righ t-handed, all manifested sudden onset of consciousness disturbance and other neurological deficits as the first aura in their life. The symp toms in all cases almost completely resolved spontaneously within 24 h , but transient occipital slowing on EEG with laterality corresponding to the side of migrainous origin lasted more than 24 h. In the cases of ACM in the critical phase, although MRI and MR angiography showed n o abnormal findings, IMP-SPECT performed within 48 h of migraine attac ks revealed a regional change in cerebral blood flow, which in one par ticular case demonstrated hypoperfusion in the left posterior cerebral artery (PCA) territory. Therefore, although ACM was diagnosed clinica lly by exclusion, SPECT was thought helpful for the diagnosis of ACM. We speculated that transient hypoperfusion affecting the dominant-side d PCA territory involving the medial temporal structures was responsib le for the confusion with amnesia in ACM, in contrast to the lack of c onfusion or amnesia in the case of MI showing cystic encephalomalacia in the right thalamic and hippocampal regions. (C) 1997 Elsevier Scien ce B.V.