Cerebellar infarction, visual aura, and patent foramen ovale: A case report with pathophysiological considerations
6 affiliations
- 1Neurologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, , Rome,
- 2Department of Neuroscience, Università Cattolica del Sacro Cuore, , Rome,
- 3UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, , Rome,
- 4Physical Education and Health Center, Nagaoka University of Technology, Niigata,
- 5Sendai Headache and Neurology Clinic, Sendai,
- 6Department of Neuroscience, , Lamezia Terme,
Abstract
Background Brain magnetic resonance imaging (MRI) abnormalities, including small infarcts in the posterior circulation, were historically described in patients with migraine with aura. However, recent population-based studies and meta-analyses have questioned the consistency of this association. The pathophysiological significance of these MRI findings remains uncertain, particularly when detected outside the acute or subacute phase. Case We report a 29-year-old woman with a 15-year history of migraine without aura who experienced two consecutive episodes of first-ever visual aura within 24 h. Brain MRI performed three days after symptom onset disclosed a small diffusion-weighted imaging/fluid-attenuated inversion recovery (FLAIR)-hyperintense focus in the left cerebellar hemisphere, without clear apparent diffusion coefficient restriction. Follow-up MRI performed two months later demonstrated marked regression of the previously described cerebellar abnormality, with persistence of a small residual T2/FLAIR hyperintense focus consistent with a gliotic sequela. Cardioembolic workup revealed a patent foramen ovale with a mild right-to-left shunt. The patient was started on amitriptyline and later on onabotulinumtoxinA, with no further aura episodes during 12 months of follow-up. Conclusion This case supports a vascular-neurogenic continuum linking paradoxical microembolism, cortical spreading depression, and small ischemic lesions in selected patients with migraine with aura and raises the question of how often similar lesions are misclassified as non-specific gliosis when imaging is performed remote from the inciting event.
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BibTeX
@article{romozzi2026cerebellar,
title = {{Cerebellar infarction, visual aura, and patent foramen ovale: A case report with pathophysiological considerations}},
author = {Marina Romozzi and Silvia Falso and Giuseppe Garignano and Martina Petracca and Catello Vollono and Masahito Katsuki and Yasuhiko Matsumori and Federico Tosto},
journal = {Cephalalgia Reports},
year = {2026},
month = oct,
doi = {10.1177/25158163261500746},
url = {https://doi.org/10.1177/25158163261500746},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Cerebellar infarction, visual aura, and patent foramen ovale: A case report with pathophysiological considerations
AU - Marina Romozzi
AU - Silvia Falso
AU - Giuseppe Garignano
AU - Martina Petracca
AU - Catello Vollono
AU - Masahito Katsuki
AU - Yasuhiko Matsumori
AU - Federico Tosto
PY - 2026
DA - 2026/10/26
JO - Cephalalgia Reports
DO - 10.1177/25158163261500746
UR - https://doi.org/10.1177/25158163261500746
AB - Background Brain magnetic resonance imaging (MRI) abnormalities, including small infarcts in the posterior circulation, were historically described in patients with migraine with aura. However, recent population-based studies and meta-analyses have questioned the consistency of this association. The pathophysiological significance of these MRI findings remains uncertain, particularly when detected outside the acute or subacute phase. Case We report a 29-year-old woman with a 15-year history of migraine without aura who experienced two consecutive episodes of first-ever visual aura within 24 h. Brain MRI performed three days after symptom onset disclosed a small diffusion-weighted imaging/fluid-attenuated inversion recovery (FLAIR)-hyperintense focus in the left cerebellar hemisphere, without clear apparent diffusion coefficient restriction. Follow-up MRI performed two months later demonstrated marked regression of the previously described cerebellar abnormality, with persistence of a small residual T2/FLAIR hyperintense focus consistent with a gliotic sequela. Cardioembolic workup revealed a patent foramen ovale with a mild right-to-left shunt. The patient was started on amitriptyline and later on onabotulinumtoxinA, with no further aura episodes during 12 months of follow-up. Conclusion This case supports a vascular-neurogenic continuum linking paradoxical microembolism, cortical spreading depression, and small ischemic lesions in selected patients with migraine with aura and raises the question of how often similar lesions are misclassified as non-specific gliosis when imaging is performed remote from the inciting event.
SN - 2515-8163
ER -