Medical mystery | What caused a teenager’s right side to become numb?
His symptoms, which include numbness on one side and garbled speech, immediately made parents fear a stroke.
A 16-year-old lacrosse player woke up one morning and immediately knew that something was wrong. He had a bad headache and his right arm felt tingly and numb. He sat up in bed, and as he tried to move his fingers and toes, his entire right side felt weird.
Scared and upset, he crawled to his parents’ room. When he tried to tell them what was going on, his speech was garbled. Worried that he was having a stroke, his dad called 911 and they were taken by ambulance to the nearest emergency room.
In the ER, the patient was rushed into a treatment room. His vital signs and blood oxygen level were normal. The ER doctor noticed that the patient seemed confused and sounded drunk. He then performed a thorough neurologic examination, revealing weakness and decreased sensation in his right arm and leg. A stroke would be unusual in a teenager, but was a real possibility and an emergency where every minute matters.
» READ MORE: If a stroke can strike anyone, how important are lifestyle changes to reduce the risk factors?
A CT scan of his head was immediately ordered. It showed no signs of a stroke, as well as no hemorrhage. An MRI was also done to check for a brain tumor or signs of inflammation. Again, the scans came back normal.
The ER doctor considered other possibilities: An infection like meningitis was unlikely because the patient had no fever. Also, his blood tests did not show signs of infection. Lyme disease tests were negative. Drug and alcohol screens were also negative. Because he played lacrosse, a concussion seemed possible, but the patient denied experiencing any head trauma. A seizure can cause symptoms and confusion, but there were no abnormal movements reported.
At this point, his headache was throbbing and spread to behind his right eye. Typical pain medications were not working.
Solving a medical mystery
The team asked more questions. When asked about family history, his dad said that he and his brother sometimes experienced headaches with tingling on one side of the body. With this additional information, the doctor suspected that the patient was having a migraine.
The doctor gave the patient intravenous fluids and a combination of medications known as a “migraine cocktail.” Success! After treatment and sleep, the patient started feeling better and was ready to go home.
Diagnosis: hemiplegic migraine, a rare variant of migraines.
» READ MORE: Get to know the basics about migraine headaches
Hemiplegic migraines usually start between the ages of 12 to 17 years, causing on average three episodes per year in patients. An aura consisting of weakness, numbness, and incoordination is the hallmark of hemiplegic migraine. Motor symptoms most often start in the one hand and gradually spread up into the arm and then the face.
The one-sided symptoms may switch sides during attacks. Both sides can be involved in up to one-third of patients. The auras of hemiplegic migraine usually last more than an hour. The hеаԁаches can occur on both sides or one side of the head, and one-sided headaches may be on the same or opposite side of the motor symptoms. Headache severity ranges from mild to excruciating.
Follow up care and guidance
After being discharged from the ER, the patient followed up with a neurologist. The neurologist prescribed a rescue medicine to prevent attacks to take as soon as he starts to get symptoms. He also recommended lifestyle management to help prevent attacks including:
Diet: Migraine sufferers must eat three meals a day. Breakfast is a common meal to remind teenagers about.
Sleep: Adequate sleep is essential for health and well-being, especially for headache sufferers. Teens require 8-10 hours of sleep per night.
Hydration: Poor hydration is often the cause of migraines. It is helpful to give families a fluid goal in ounces as this can be one of the most powerful interventions. Teenagers should aim to drink their weight in kilograms, in ounces (e.g., a 60 kg child should drink 60 ounces of water per day).
Caffeine: Although caffeine is present in a number of over-the-counter medications for migraines, the frequent intake of caffeinated products is one of the most common causes of rebound headache.
Exercise: Regular exercise has been shown to decrease migraine frequency and intensity.
Over the next several months, the patient needed to take the rescue medication twice but was able to prevent severe attacks. He didn’t miss any school and even better, he was back on the field enjoying lacrosse season!
Sienna McNett is a pediatric resident and Rima Himelstein is an adolescent medicine specialist at Nemours Children’s Health, Delaware.