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Intracerebral Hemorrhage Caused by Migraine

Nitin K. Sethi, MD
JAMA Neurol. 2013;70(5):653. doi:10.1001/jamaneurol.2013.2200.
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Gokhale et al1 reported the case of a 54-year-old man with left parietooccipital hemorrhage and hypothesized that it was likely caused by migraine. As the authors themselves pointed out, intracerebral hemorrhage due to migraine is exceedingly rare, with only a few cases reported in the literature. Critical review of these cases reveals that in all migraines as a cause of intracerebral hemorrhage, there was a diagnosis of exclusion. In the authors' reported case too there were a few inconsistencies that cause one to stop and ponder. First their patient's typical migraine headaches preceding the intracerebral hemorrhage were consistently lateralized to the left parietooccipital area. This is highly atypical for migraine episodes, which usually demonstrate shifting laterality. A vascular malformation, such as an arteriovenous malformation or an arterial-dural fistula causing the lobar hemorrhage and which was self-obliterated by the time of the catheter angiogram, is still a possibility. It may be prudent to repeat the angiogram after an interval of 3 to 6 months.

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