Prosopagnosia as symptom of migraine with aura a

Prosopagnosia as symptom of migraine with aura: a case report 1, 2 PS Sándor, 1 GP Morath, 3 K Hess, 2 H Kaube, & Pain Unit, Neurology Dept. , University Hospital Zurich, Switzerland 1, 4 RM Agosti & 3 M Regard 1 Headache 2 Headache Group, Institute of Neurology, Queen Square, London, United Kingdom 3 Neurology 4 Zurich Dept, University of Zurich, Switzerland Hirslanden Headache Center, Zurich, Switzerland In this patient IHS migraine is associated with stereotyped aura consisting of visual symptoms and isolated propopagnosia without any persisting neuropsychological deficits. The episodic nature and the stereotypic association with the visual aura support migraine aura as the most likely etiology for the prosopagnosia in our patient. Case Background During prosopagnosia a face is recognized as such, but not as a familiar face. Dysfunction or lesions of the right fusiform/ lingual gyrus can cause prosopagnosia (Fig. 1). Migraine aura causes focal cortical dysfunction and can be associated with complex neuropsychological disturbancies, sporadically including prosopagnosia. A ant. Discussion B post. R L Figure 1: minimal dysfunctional area in prosopagnosia (grey): right occipito-temporal (infero-medial) A = Mediale Ansicht der rechten Hemisphäre, B = axialer Schnitt durch beide Hemisphären. (from: Schnider A. Verhaltensneurologie – Die neurologische Seite der Neuropsychologie. Thieme Verlag 1997. ) References 1. Sandor PS, Roon RI, Ferrari MD, van Dijk JG, Schoenen J. Repeatability of the intensity dependence of cortical auditory evoked potentials in the assessment of cortical information processing. Cephalalgia. 1999; 19: 873 -9 2. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 8: 307 -10. • 58 year old patient, migraine without aura since age 20 • attack frequency: 1 / month. • since age 52, migraine with stereotyped aura, 2 -3/month • semiology of the aura: - start with slowly spreading “coloured rings” - after 10 min: concentric visual field restriction Then: - inability to recognize faces of familiar persons - description of the faces as “whitish discs” - preserved ability to see and recognize normally. . . parts of the face (e. g. nose, mouth). . . other body parts. . . the environment. . . objects normally. • duration of prosopagnosia: 10 -15 min • slow disappearance over 5 min • at the same time normalization of visual field • followed by 12 hours of - unilateral, throbbing, headache (moderate intensity) - accompanied by sensory hypersensitivity • Family history: negative • Medical history: - one episode of transient global amnesia - slightly elevated blood pressure • Neurological : normal • Medical examinations: unremarkable • MRI: few small vascular lesions • Blood test: slightly raised liver enzymes. • Doppler, Duplex, EEG normal.