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A 37-year-old woman developed increasingly frequent bifrontal migrainous headaches, some of which woke her from sleep. Neurological and ophthalmological examinations were normal. We organised brain imaging to exclude a structural cause.
MR scan of brain showed a spatially extensive right hemispheric abnormality (figure 1A–C); axial T2-weighted (figure 1A,B) and coronal fluid-attenuated inversion recovery sequences (figure 1C) showed high signal within the frontoparietal subcortical white matter of the right hemisphere. Juxtacortical white matter was preserved, with no lateralised volume loss. Screening blood tests for known causes of white matter disease or leukodystrophy were normal or negative (including a clotting screen, lipid profile, haemoglobin A1c, very-long-chain fatty acids, pristanic acid, …
Contributors RTI: drafting/revising the manuscript, data acquisition, accepts responsibility for conduct of research and final approval. PS: drafting/revising the manuscript, accepts responsibility for conduct of research and final approval.
Funding RTI is funded by the Guarantors of Brain, UK postdoctoral clinical fellowship.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Owen Pickrell, Swansea, UK.