RESUMO
Introducción. La migraña con pleocitosis (MP) de llíquido cefalorraquídeo (LCR) es un cuadro clínico consistente en cefaleas intermitentes acompañadas de episodios deficitarios neurológicos transitorios y pleocitosis linfocitaria, que se suceden durante un período variable y con resolución espontánea. Presentamos un caso de MP de evolución atípica con buena respuesta a corticoides. Caso clínico. Se trata de un varón de 27 años, sin antecedentes familiares ni personales de migraña, que inicia con episodios de cefalea intensa, precedidos de déficit neurológico (disfasia y hemiparesia derecha) de duración variable (incluso horas). El estudio seriado del LCR reveló una marcada linfocitosis (400/mm3) con incremento de la presión intracraneal (PIC) (más de 30 mmHg). El resto de las exploraciones practicadas (estudio microbiológico de LCR y sangre, inmunidad humoral y celular, angiorresonancia magnética y hormonas tiroideas, entre otras) fueron normales. La exploración neurológica en los días posteriores reveló una leve paresia del recto externo derecho, que se atribuyó a su hipertensión intracraneal y que claramente incapacitó al paciente. Dada la recurrencia de las crisis y la persistente elevación de la PIC, se inicia un tratamiento con prednisona (1 mg/kg/día, en pauta descendente) y se consigue la remisión clínica y la normalización del LCR en el plazo de dos meses. Discusión. Aportamos la descripción de este paciente afectado de MP por la atipicidad de su evolución (paresia del VI par derecho secundaria al aumento de PIC) y la posibilidad de asociar corticoides en aquellos casos en que se cuestione la benignidad de dicha entidad (AU)
Aims. Migraine with cerebrospinal fluid pleocytosis is a clinical pattern consisting in intermittent headaches accompanied by episodes of transient neurological deficit and lymphocytic pleocytosis, which last for varying lengths of time and have a spontaneous resolution. We describe the case of migraine with pleocytosis (MP) with atypical progression that responded well to corticoids. Case report. A 27-year-old male with no familial or personal history of migraine who began with bouts of intense headaches that were preceded by neurological deficit (dysphasia and hemiparesis of the right-hand side) lasting varying amounts of time (including hours). The serial study of cerebrospinal fluid (CSF) revealed a notable degree of lymphocytosis (400/mm3 ) with increased intracranial pressure (ICP) (> 30 mmHg). The other explorations that were performed (microbiological study of CSF and blood, humoral and cellular immunity, MR angiography and thyroid hormones, among others) were all normal. The neurological exploration carried out in the following days revealed a mild paresis of the right lateral rectus muscle, which was attributed to the intracranial hypertension and which clearly disabled the patient. As a consequence of the recurrence of the seizures and the long-lasting increase in ICP, therapy was begun with 1 mg/kg/day of prednisone, at a descending rate; clinical remission and normalisation of the CSF was achieved within a period of two months. Discussion. We describe this case of MP because of how atypical the progression was (paresis of the right abducent nerve secondary to the increase in ICP) and the possibility of associating corticoids in cases in which the benignity of the entity is in doubt (AU)
. Aims. Migraine with cerebrospinal fluid pleocytosis is a clinical pattern consisting in intermittent headaches accompanied by episodes of transient neurological deficit and lymphocytic pleocytosis, which last for varying lengths of time and have a spontaneous resolution. We describe the case of migraine with pleocytosis (MP) with atypical progression that responded well to corticoids. Case report. A 27-year-old male with no familial or personal history of migraine who began with bouts of intense headaches that were preceded by neurological deficit (dysphasia and hemiparesis of the right-hand side) lasting varying amounts of time (including hours). The serial study of cerebrospinal fluid (CSF) revealed a notable degree of lymphocytosis (400/mm3 ) with increased intracranial pressure (ICP) (> 30 mmHg). The other explorations that were performed (microbiological study of CSF and blood, humoral and cellular immunity, MR angiography and thyroid hormones, among others) were all normal. The neurological exploration carried out in the following days revealed a mild paresis of the right lateral rectus muscle, which was attributed to the intracranial hypertension and which clearly disabled the patient. As a consequence of the recurrence of the seizures and the long-lasting increase in ICP, therapy was begun with 1 mg/kg/day of prednisone, at a descending rate; clinical remission and normalisation of the CSF was achieved within a period of two months. Discussion. We describe this case of MP because of how atypical the progression was (paresis of the right abducent nerve secondary to the increase in ICP) and the possibility of associating corticoids in cases in which the benignity of the entity is in doubt (AU)
