Cerebellar infarction in a case suspected migraine with brainstem aura

Abstract

A 45-year-old man, who encountered sudden loss of consciousness during driving followed by transient defect of his right visual field, was brought to our hospital. He presented no neurological deficits, but diffusion weighed images on magnetic resonance image revealed left cerebellar infarction. Blood tests excluded diabetes, hyperlipidemia, and collagen diseases. He was suffering from habitual headache with scintillating scotoma from 18-year-old, and was diagnosed migraine with aura. Nine days before admission, he noticed non-disable headache followed by behavior abnormality and delirious state. Hence he was delivered to another hospital. He recovered after one-day-sedation using midazolam and dexmedetomidine, and migraine with brainstem aura was suspected in terms of his past visual defects and consciousness disturbance. Since his headache persisted with fluctuation, he was taking rizatriptan, which was prescribed for his typical migraine with aura, for nine days. The usage of triptans is assumed to be contraindication to migraine with brainstem aura because of their vasocontractive effect. Concerning this case, his infarction was distributed as watershed area between anterior and posterior inferior cerebellar artery without cerebrovascular risk factors. Therefore, frequent use of rizatriptan possibly induced cerebral infarction by vasoconstriction. We report the case of a patient suspected migraine with brainstem aura, who experienced cerebellar infarction, presumably triggered by continual administration of rizatriptan.