[Hemiplegic migraine complicated with coronary vasospasm].

There are many theories and hypotheses concerning with the pathogenesis of migraine. The clinical effectiveness of vasoactive drugs and many investigations on the cerebral blood flow in patients with migraine strongly support a vascular theory. In present paper we report a case of 26-year-old Japanese male, who suffered from hemiplegic migraine and coincidental coronary vasospasm, and discussed the pathogenesis of migraine. In October 1986, the patient developed the first attack of throbbing headache in the left temporal area with nausea and vomiting, following typical visual aura. One week later, he developed the second migrainous attack and then he felt his right extremities paralyzed and numb. Although the headache and weakness resolved within one hour, similar migrainous attack with transient hemiparesis repeated two or three times a month. Although the longest period required for resolving weakness was three days, the MRI, the CT and the electroencephalogram revealed no significant abnormality. In January 1987, during his stereotyped attack of hemiplegic migraine, he also developed oppressive feeling on his anterior chest and these symptoms resolved within fifteen minutes. Because the results of Holter electrocardiogram and ultrasound echocardiogram indicated angina pectoris, a coronary angiography was performed in February 1987. During the angiographical procedures, he began to complain of the oppressive feeling on his anterior chest, and the coronary angiography revealed the definite vasospasm in the anterior descending branch of the left coronary artery. Sublingual nitroglycerin administration resolved the vasospasm, but thereafter the patient developed his stereotyped hemiplegic migrainous attack.(ABSTRACT TRUNCATED AT 250 WORDS)