Definition: Rare complication of migraine with aura, leading to ischemic stroke.
Pathophysiology:
Vasospasm: Prolonged arterial spasm during aura, causing hypoperfusion.
Thrombosis: Platelet activation and hypercoagulability may contribute.
Hypoxia: Reduced cerebral blood flow during aura.
Risk Factors:
Younger age (often <50 years).
Long-standing migraine with aura (especially if frequent).
Smoking, oral contraceptives, or other prothrombotic states.
Diagnosis:
Imaging: MRI with diffusion-weighted imaging (DWI) shows acute ischemic lesions, often in the posterior circulation (e.g., cerebellum, occipital lobes).
Exclusion of other causes: Rule out cardioembolic sources, dissection, or vasculitis.
Management:
Acute: Thrombolysis if within 4.5 hours (if no contraindications).
Prevention:
Avoid triggers (e.g., smoking, OCPs).
Consider antithrombotic therapy (e.g., aspirin, clopidogrel) if recurrent.
Migraine prophylaxis (e.g., beta-blockers, topiramate) if indicated.
Rationale: Migraine with aura is a risk factor for stroke, and MI is a severe manifestation requiring prompt evaluation and management to prevent recurrence.