Migraine with aura, bipolar depression, ACM aneurysm. A case report.
B.D. is a 48-year-old professional woman. She has been suffering for migraine since she was 28, but she did not have serious problems until last year, when headache episodes became more frequent and it was necessary an admission to emergency room. At the beginning, the events were about 6 per month, lasting from 2 to 4 days, beating and of high intensity together with nausea, vomit, photo and phonophobia and visual area. Looking at the anamnesis, we report a psychiatric treatment since about ten years, because of type II bipolar disorder. In spite of the psychopharmacological treatment, as the patient came in our Regional Headache Center, she talked about 7 events with aura (scintillating scotomas, emianopsia) per month, lasting 2-4 days with photo and phonophobia, nausea, crying crisis, anxiety. Although the neurological examination was normal, the sudden aggravation of pain symptomatology and the unresposiveness to usual painkillers, suggested a cerebral CT and CT-angiography. CT and CT-angiography discovered the presence of an aneurysm of the right middle cerebral artery (MCA) of 4 mm diameter, with parietal irregularities. The patient was operated to reduce the hemorrhagic risk, with a positive result. One year after the operation, the patient reports a decrease of headache events with a frequency of 2 per month, lasting only a few hours, which she can now solve with COXIB.
de Filippis
Sergio
S
Regional Referral Headache Centre, Department of Medicine, Sant'Andrea Hospital, II School of Medical Sciences, University La Sapienza, Via di Grottarossa 1035, I-00189 Rome, Italy. sergio.defilippis@uniroma1.it
Salvatori
Emiliano
E
Bozzao
Alessandro
A
Fantozzi
Luigi Maria
LM
Martelletti
Paolo
P
D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D001921:Brain / Q000098:blood supply* / Q000473:pathology / Q000503:physiopathology*; D002533:Cerebral Angiography; D015897:Comorbidity; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D020325:Migraine with Aura / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D019635:Neurosurgical Procedures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D016861:Cyclooxygenase Inhibitors