Abstract

Persistent aura without infarction (PAWOI) is diagnosed when aura symptoms persist for more than 1 week without radiographic evidence of infarction and unaccounted for another condition at the patient with migraine with aura. We report a case of PAWOI aggravated by triptans. Fifteen years-old girl had severe headaches which started 2 years ago, which was more frequently occurred from 9 month ago. Nausea, vomiting, photophobia and phonophobia were accompanied with her headache. She frequently saw flashing lights just before beginning of headache. On the first visit of our clinic, she was diagnosed with migraine with visual aura and was prescribed with sumatriptan 50mg twice a day for PRN use. Shortly after taking sumatriptan, she experienced sensory changes and weakness of four extremities, which caused paralysis of lower extremities, especially right side. Laboratory findings were normal in CSF study, brain MRI and MRA, SPECT, EMG and NCV. Careful history taking revealed that she had various focal neurologic symptoms such as hypercusia, tinnitus, loss of consciousness, vertigo, diplopia, visual symptoms and weakness. She was diagnosed with basilar-type migraine, sporadic hemiplegic migraine and PAWOI provoked by triptan. After 21 days, she was fully recovered. On discharge she was received topiramate and verapamil for prophylaxis. Two years later, she was admitted for persistent sensory symptoms and losing strength in her right leg after taking naratriptan 2.5 mg twice a day from another clinics. She was discharged after 3 weeks with full recovery. PAWOI is uncommon, but one should be cautious to use triptans for basilar-type migraine or hemiplegic migraine in adolescents.