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IHS Diagnosis ICD-10
1.2.5 Sporadic hemiplegic migraine G43.105  

Description:

Migraine with aura including motor weakness but no first- or second-degree relative has aura including motor weakness.

Diagnostic criteria:

  1. At least 2 attacks fulfilling criteria B and C
  2. Aura consisting of fully reversible motor weakness and at least one of the following:
    1. fully reversible visual symptoms including positive features (eg, flickering lights, spots or lines) and/or negative features (ie, loss of vision)
    2. fully reversible sensory symptoms including positive features (ie, pins and needles) and/or negative features (ie, numbness)
    3. fully reversible dysphasic speech disturbance
  3. At least two of the following:
    1. at least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes
    2. each aura symptom lasts ≥5 minutes and <24 hours
    3. headache fulfilling criteria B-D for 1.1 Migraine without aura begins during the aura or follows onset of aura within 60 minutes
  4. No first- or second-degree relative has attacks fulfilling these criteria A-E
  5. Not attributed to another disorder1

Note:

  1. History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12, or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but attacks do not occur for the first time in close temporal relation to the disorder.

Comments:

Epidemiological studies have shown that sporadic cases occur with approximately the same prevalence as familial cases. The attacks have the same clinical characteristics as those in 1.2.4 Familial hemiplegic migraine.

Sporadic cases always require neuroimaging and other tests to rule out other cause. A lumbar puncture is also necessary to rule out pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. This condition is more prevalent in males and often associated with transient hemiparesis and aphasia.

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