Meningeal Hyperperfusion Visualized by MRI in a Patient With Visual Hallucinations and Migraine

A 41-year-old patient with a history of migraine but with no history of seizures had intermittent prolonged and variable complex visual hallucinations and illusions lasting 9 days, accompanied by unilateral headache. Electroencephalography during these visual symptoms revealed occipital epileptic discharges. Distinction between focal migrainous attacks and ictal phenomena was difficult. Magnetic resonance imaging showed a lesion in the right visual cortex probably related to low perfusion and hyperemia of meningeal vessels, representing the rarely described transient MRI changes associated with migraine. Continued treatment with antiepileptic drugs and calcium-channel blocking agents completely resolved the headache and visual symptoms, while minor EEG changes persisted. After discontinuation of treatment, a second attack occurred with a similar and reversible pattern on EEG.