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migraine related strokes???
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migraine related strokes???


  I'm a 29 year old white female with a history of migraines since childhood.At the age of 19, while 4-6 wks. pregnant with my second child i  had the first of four supposed " migrraine related" strokes. The first"stroke" caused right sided paralysis and minimal short term memory loss. I was sent to rehab and was eventually taught to walk again with the aid of a walker. Four months after my first "stroke" i had another one , but was only left extremely weak,not paralyzed again. I was kept a few days for observation, given a prescription for Inderal and released. The neurologist told me that it was another "stroke" and it was caused by migraines and my pregnancy.                                                                       Three years passed until my next"stroke" which also left me weak again ,but with no paralysis. My new neurologist wasn't any help, "nothing we can do, just complicated migraines" , the only thing he was sure of was that it wasn't pregnancy induced, as I had had a tubal ligation after the birth of my daughter. The doctor swwitched me to Calan SR, ran every type of test imagineable and sent me home. Since then I've been on calan and fioricet to help with my migraines.                                                                        Almost four years passed until my fourth and most recent "stroke". This one was by far the most severe. My whole right side was paralyzed, moderate short term memory loss and moderately slurred speech. I had everything from CT scan, MRI, to lab tests to check for connective tissue disorders and MS. Every test came back normal as usual. I stayed in rehab and relearned how to walk,etc. again. Two months later I was released and followed up for six additional months of physical therapy. Nine months after my fourth "stroke" I was walking with no assistive devices.                                                                           It has been 15months now and I have residual righht sided weakness,migraines at least 3 days a week and short term memory loss. A few of my doctors have given up on trying to figure out what is wrong with me and have even said I may have "conversion disorder" that's causing my so called "strokes", even though I've had no precipating life events to cause such a condition;ie; child abuse of any type, rape, abusive husband, mental illness. The only thing I've ever had has been depression x2. My first bout of depression came in 1993(after my third"stroke") after my youngest sister was diagnosed with leukemia. My second bout appeared after my recent "stroke".                                                                          If anyone can be of any help concerning complicated/complex migraines or so called "migraine related strokes" I would appreciate it.
Dear Shannon:
I am sorry to hear about your problems.  There is an increase in strokes with females who have migraines and are pregnant or on birth control pills, but the numbers are very small.  Usually, it is due to the patient having a hypercoagulable state.  The number is less now that the low estrogen pill has become the mainstay of BCPs (birth control pills).  The recurrent episodes would begin to lead me away from the diagnosis of atypical migraines.  Although it is possible, since it was a relative new occurance of an atypical feature of an old problem (your usual migraine headache), it's repeated nature, it's non-responsive to migraine agents, and the degree of impairment that varies, I would suggest that you might want to seek an alternative explanation.  The absolutely normal tests, MRI etc would lead me away from the usual players or diseases that can give one these symptoms.  This has the flavor of a mitochondrial disease.  There is a rare form of mitochondrial disease called MELAS (mitochondrial
encephalopathy, lactic acidosis, and stroke-like symptoms).  I would seek a neurologist out who might be familar with this disease.  The lab work that might help is a lactic acid level, ammonia level, and pyruvate level; best taken during one of your episodes.  If this is positive then I would get additional tests of urine and serum organic acids, serum amino acids, acyl carnitines of urine and serum.  If these indicate a possible mitochondrial disease then an electron transport study and DNA analysis for MELAS DNA changes.  There are several places in the USA that are very competent in this entity.  They are located in Atlanta, Cleveland Clinic (here), Boston, San Diego.  Although rare, these events may also be epilepsy but that would be a remote consideration.  So, maybe a second opinion would be best.  I guess there could still a chance that these are atypical migraine but I think that you should get a second opinion.
Sincerely,
CCF Neuro[P] MD, RPS




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