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NEUROLOGY 2005;64:2145-2147
© 2005 American Academy of Neurology
Brief Communications

Opening of the blood-brain barrier preceding cortical edema in a severe attack of FHM type II

J. P. Dreier, MD, K. Jurkat-Rott, MD, G. C. Petzold, MD, O. Tomkins, MSc, R. Klingebiel, MD, U. A. Kopp, F. Lehmann-Horn, MD, A. Friedman, MD, PhD and M. Dichgans, MD

From the Departments of Neurology (Drs. Dreier and Petzold, U.A. Kopp), Experimental Neurology (Drs. Dreier and Petzold), Neuroradiology (Dr. Klingebiel), Physiology (Dr. Friedman), Charité University Medicine Berlin, Berlin, Germany; Department of Applied Physiology (Drs. Jurkat-Rott and Lehmann-Horn), Ulm University, Ulm, Germany; Department of Neurosurgery (Dr. Friedman, O. Tomkins), Zlotowski Center for Neuroscience, Ben-Gurion University, Beersheva, Israel; and Department of Neurology (Dr. Dichgans), Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.

Address correspondence and reprint requests to Dr. Jens P. Dreier, Department of Neurology, Charité Campus Mitte, Charité University Medicine, Schumannstr. 20/21, 10117 Berlin, Germany; e-mail: jens.dreier{at}charite.de

The authors report a patient with familial hemiplegic migraine type II who developed a long-lasting attack including fever, right-sided hemiplegia, aphasia, and coma. Quantitative analysis of early gadolinium-enhanced MRI revealed a mild but significant left-hemispheric blood-brain barrier (BBB) opening limited to the cortex and preceding cortical edema. The findings suggest that the delayed cortical edema was vasogenic in the severe migraine aura variant of this ATP1A2 mutation carrier.

Supported by grants BMBF Berlin Neuroimaging Center 01GI9902/4 (J.P.D.), DFG-SFB 507 A1 (J.P.D.), and Wilhelm Sander-Stiftung No. 2002.028.1 (J.P.D.).

Received December 12, 2004. Accepted in final form March 15, 2005.




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