[Recurrent hemispheric symptoms without proof of ischemia].

Anamnesis And Clinical Findings: Over the last 6 years, a 48-year-old patient recurrently experienced passing neurological left hemispheric symptoms of varying strength. Because of the patient's distinctive cardiovascular risk profile, these symptoms were diagnosed as transitory ischaemic episodes. On inquiry, the patient now reported frequent headaches in close temporal connection to the events.

Examinations: Repeated imaging of the neocranium using various techniques (CCT, cMRT, MRT-angiography) revealed no conspicuous features. Duplex sonography of the brain feeding arteries, echocardiography, EEG and 24h-ECG also gave findings within the normal range for the patient's age group. Clinical chemistry showed increased values for cholesterol and triglycerides. Incidentally, a moderate upper airway resistance syndrome was identified during polysomnography.

Diagnosis: Suspected migraine with aura in terms of a sporadic hemiplegic migraine.

Treatment And Course: On administration of ASS and rizatriptane, the neurological hemispheric symptoms disappeared completely over the course of a few hours. Under prophylactic treatment with metoprolol and acetazolamide over two months, no further events have been observed up to now.

Conclusion: Recurrent, temporary neurological deficits, together with the presence of several cardiovascular risk factors, can easily be misinterpreted to be the result of an underlying cerebral ischemia. Even in cases with typical cardiovascular risk profile, a migraine with aura must be considered as one of the possible causes for hemispheric neurological symptoms.