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Table of Contents    
LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 788-789

Adult Hemimegalencephaly with Migraine as the First Symptom


Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300060, China

Date of Submission16-Dec-2019
Date of Decision08-Feb-2020
Date of Acceptance17-Jul-2020
Date of Web Publication3-May-2022

Correspondence Address:
Dr. Guanen Zhou
Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin 300060
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344681

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How to cite this article:
Liu Q, Zhao W, Zhou G. Adult Hemimegalencephaly with Migraine as the First Symptom. Neurol India 2022;70:788-9

How to cite this URL:
Liu Q, Zhao W, Zhou G. Adult Hemimegalencephaly with Migraine as the First Symptom. Neurol India [serial online] 2022 [cited 2022 Jul 3];70:788-9. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/788/344681




Sir

We report a case of hemimegalencephaly presenting with migraine as the first symptom. A 55-year-old right-handed female patient presented with complaints of recurrent episodes of the left focal headache for the past 2 years. The headache often intermittent attacks lasted for a few minutes with a frequency of 3–4 times per day. Besides, we found her mini-mental state examination score was 18/30 (the patient was illiterate), and Montreal cognitive assessment score was 19/30.

Electroencephalogram was abnormal. Magnetic resonance imaging (MRI) of the brain showed enlarged right hemisphere with smooth thickened cortex and pachygyria, indistinct gray/white differentiation. The patient suffered from intermittent headaches for 2 years, and the effect of medical treatment was poor, thus after finding the abnormality of the brain MRI, she was admitted to the neurosurgery department of another hospital for the stereotactic brain biopsy. Pathologic analysis of the right frontal lobe showed that GFAP(+), Olig2(+), IDH1(-), CD34(-), H3K27M(-), CD56(-), Neu-n(-), P53(-), ki67 labeling index was less than 1%. She was treated with oral carbamazepine 100 mg twice a day. During the follow-up period of one-and-a-half years, there was a decreased recurrence of migraines.


  Discussion Top


In this case, the patient presented with a contralateral headache rather than an ipsilateral headache. This condition has not been reported before. One study showed that nonaffected hemispheres were found to present cerebral hypoperfusion and hypometabolism, indicating that they might also have developed abnormalities in early development.[1] This may explain the clinical symptoms.

Although the pathological results of this patient showed that GFAP and Olig2 were positive, the clinical symptoms and imaging data were not consistent with glioma. However, It has been found that a patient with hemimegalencephaly treated with vagus nerve stimulation and subsequent glioblastoma development in the hemimegalencephalic hemisphere 6 years after surgery.[2] Jan Chrastina et al. thought that the genetics of hemimegalencephaly suggested a potentially increased risk of malignant glioma growth in the malformed brain.

Adult hemimegalencephaly is a rare condition. The relationship between hemimegalencephaly and brain tumor need our focus and further investigation.
Figure 1: Magnetic resonance imaging (MRI) of the brain showed enlarged right hemisphere with smooth thickened cortex and pachygyria, indistinct grey/white differentiation

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Acknowledgement

The authors declare that they have no competing interests.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Uematsu M, Haginoya K, Togashi N, Hino-Fukuyo N, Nakayama T, Kikuchi A, et al. Unique discrepancy between cerebral blood flow and glucose metabolism in hemimegalencephaly Epilepsy Res 2010;92:201-8.  Back to cited text no. 1
    
2.
Chrastina J, Novak Z, Brazdil M, Hermanova M. Glioblastoma multiforme in a patient with isolated hemimegalencephaly. J Neurol Surg Rep 2015;76:e160-3.  Back to cited text no. 2
    


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