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Recurrent migraine aura-like symptoms in an elderly woman: symptomatic cortical spreading depression?
  1. Kerstin Glössmann1,
  2. Christoph Baumgartner1,2,3,
  3. Johannes Peter Koren1,2 and
  4. Franz Riederer1,4
  1. 1Department of Neurology, Clinic Hietzing, Wien, Austria
  2. 2Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
  3. 3Sigmund Freud Private University, Vienna, Austria
  4. 4University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Franz Riederer; franz.riederer{at}


Cortical spreading depression (CSD) has been directly observed in humans with malignant stroke, traumatic brain injury and subarachnoid haemorrhage and is also considered to be the correlate of migraine aura. We report on a 76-year-old woman with new-onset episodes of headache, paraesthesia, hemiparesis and dysarthria, in whom a small cortical subarachnoid haemorrhage was diagnosed with MRI. Repeated diffusion-weighted MRI scans shortly after transient focal neurological episodes as well as diagnostic workup were normal, which makes recurrent transient ischaemic attacks unlikely. Ictal electroencephalogram recordings showed no epileptic activity. Long-term follow-up revealed a diagnosis of probable cerebral amyloid angiopathy. We propose that CSD could be a pathophysiological correlate of transient focal neurological deficits in patients with cortical bleeding.

  • headache (including migraines)
  • stroke
  • pain (neurology)

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  • Contributors KG wrote and corrected parts of the manuscript draft. She was also involved in the conception of the study. CB supervised the study and corrected the manuscript draft. JPK interpreted the EEG findings and corrected the manuscript draft. FR is responsible for the study, interpreted imaging and EEG findings, and wrote parts of the manuscript and corrected it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.