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Case Records of the Massachusetts General Hospital
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Volume 360:1656-1665 April 16, 2009 Number 16
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Case 12-2009 — A 46-Year-Old Man with Migraine, Aphasia, and Hemiparesis and Similarly Affected Family Members
Steven D. Brass, M.D., M.P.H., Eric E. Smith, M.D., M.P.H., Joseph F. Arboleda-Velasquez, M.D., William A. Copen, M.D., and Matthew P. Frosch, M.D., Ph.D.

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Presentation of Case

A 46-year-old man was seen in the neurology clinic because of hemiparesis, aphasia, and abnormalities on neuroimaging studies.

The patient had been well, except for migraine headaches, until 4 years earlier, when right-sided weakness, clumsiness, and slurred speech developed during a period of 24 hours. A neurologist at another hospital found dysarthria and right central facial weakness; decreased muscle tone in the right arm, with strength 4+/5; and normal muscle tone in the right leg, with strength 4+/5. Strength on the left side was normal, with slightly increased tone in the left arm and normal tone in the left leg. . . . [Full Text of this Article]

Differential Diagnosis

Multiple Sclerosis

Other Possible Multifocal White-Matter Lesions

Leukodystrophies

Mitochondrial Diseases

CADASIL

Clinical Diagnosis

Pathological Discussion

Anatomical Diagnosis


Source Information

From the Departments of Neurology (S.D.B.), Radiology (W.A.C.), and Pathology (M.P.F.), Massachusetts General Hospital, Boston; the Department of Neurology, Foothills Hospital, and the Department of Clinical Neurosciences, University of Calgary — both in Calgary, AB, Canada (E.E.S.); and the Departments of Neurology (S.D.B.), Cell Biology (J.F.A.-V.), Radiology (W.A.C.), and Pathology (M.P.F.), Harvard Medical School, Boston.



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