Migraine with vasospasm and delayed intracerebral hemorrhage
A. J. Cole and M. Aube
Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Three women with well-documented migraine associated with intracerebral
hemorrhage are described. In each case, migraine headaches began during
adulthood. Unusually severe and protracted headache heralded the onset of
fixed neurological deficits associated with lobar intracerebral hemorrhage.
Striking carotid artery tenderness was characteristic. Except for a history
of migraine, no cause for intracerebral hemorrhage could be established. In
each case arteriography showed extensive spasm of the appropriate
extracranial or intracranial artery. Surgical pathology following
evacuation of two hematomata demonstrated signs of vessel wall necrosis
associated with subacute inflammatory changes. Vasospasm associated with
severe migraine attacks may result in ischemia of intracranial vessel
walls, leading to necrosis and subsequent vessel rupture when perfusion
pressure is restored.
