ACUTE CONFUSIONAL MIGRAINE (ACM). A REVIEW OF 90 CASES SEEN IN CHILDREN AND ADOLESCENTS (C/A)

Objectives: To analyze C/A who have ACM. To better define, increase awareness, and offer evaluation and treatment options.

Methods: A retrospective review of 680 C/A with HA between 2001–2003. 280/680 patients had migraine, 22/280 had ACM. An additional 68 patients were abstracted from the literature (1966–2005). Patients with basilar artery and hemiplegic migraine were excluded.

Results: Age range was 6–17 with a mean of 12 years. 56 males/34 females. 59% had a history of migraine, 82% had a family history of migraine. Proximate head trauma was noted in 37%. 34% had recurrent ACM. Episodes lasted from 1–24 hours, mean of 5.3 hours. Toxicology in 76 patients, all negative. CSF in 19 patients was all normal. Cranial imaging in 63 patients, 60 were normal, 3 had unrelated abnormalities. EEG on 64 occasions showed unilateral or bilateral slowing in 48. In addition to HA, symptoms included disorientation 100%, amnesia 80%, speech impairment 70%, emesis 55%, agitation 55%, visual disturbances 40% and somnolence in 37%. Conclusion: ACM occurs more frequently in C/A than in adults. It occurs in (up to 7%) of C/A with migraine. It is more common in males and is often preceded by trauma. The confusion and agitation last hours and are relieved by sleep. The attacks are recurrent. Patients are amnestic for the episodes. ACM is alarming for patents/teachers/and physicians. It is necessary to rule out life threatening and reversible etiologies: drug intoxication, CNS infection, and epilepsy. Spreading depression with resultant cortical dysfunction could account for the symptoms. Once other etiologies have been excluded, attempt to sedate the patient to avoid the complications of agitation, and aggression. If recurrent attacks of migraine and/or ACM occur – prophylactic medication should be considered.