1.4.4 Migraine aura-triggered seizure

Identification: Female patient, 32 years old, engineer.

Clinical History:
The patient reports a history of migraine with aura since adolescence, characterized by visual symptoms (scintillating scotomas) followed by unilateral pulsatile headache, photophobia, and phonophobia. In the past 6 months, she has experienced episodes of migraine aura without associated headache, lasting 20 to 30 minutes. Two weeks ago, during an aura episode, the patient experienced, for the first time, a generalized tonic-clonic seizure lasting approximately 2 minutes, accompanied by lateral tongue biting and urinary incontinence. After the seizure, she reported mental confusion and drowsiness for about 30 minutes.

Physical and Neurological Examination:
On examination, the patient was conscious, oriented, and without focal neurological deficits. Fundoscopy showed no abnormalities. Blood pressure and vital signs were within normal limits.

Complementary Exams:

Cranial Magnetic Resonance Imaging: No structural lesions or signs of vascular malformations.

Electroencephalogram (EEG): Epileptiform discharges in the left occipital region, compatible with cortical irritative activity.

Cerebral MR Angiography: No evidence of vascular anomalies.