A 58-year-old woman with a 10-year history of migraine without aura presents to the emergency department after experiencing sudden-onset weakness of her right arm and hand that began 40 minutes ago while she was at work. She reports the weakness has nearly completely resolved by the time of evaluation. She denies headache, visual changes, speech difficulty, or sensory symptoms during this event. Vital signs are BP 148/94 mmHg, HR 87/min, RR 16/min, temperature 37.2°C, SpO2 98% on room air. Neurologic examination is now normal with full strength in all extremities. CT head without contrast is unremarkable. MRI brain with diffusion-weighted imaging shows no acute infarction. Carotid and vertebral ultrasound show normal flow velocities with no stenosis. Which of the following is the most likely diagnosis?
- A)Transient ischemic attack
- B)Hemiplegic migraineGABARITO
- C)Todd paralysis from subclinical seizure
- D)Functional neurological disorder
- E)Cervical artery dissection
Explicação
Hemiplegic migraine is a rare variant of migraine with aura characterized by transient hemiparesis or hemiplegia that occurs during the aura phase, typically preceding or accompanying headache. Key diagnostic features present in this case include: (1) young to... Ver explicação completa e trilha adaptativa →