1.2.3.2 Sporadic hemiplegic migraine (SHM)

A 34-year-old chef reports episodes affecting his vision, having now had at least five in total. He describes a warning phase that spreads slowly over some six or seven minutes rather than appearing instantly, starting with sparkling, shimmering lights visible only in his right eye that his left eye does not share at all, before spreading into a wider zigzag pattern across his whole field of view. One symptom clearly gives way to the next rather than arriving all together. Towards the end his right hand becomes weak and slow to respond. Every element of the disturbance, from the eye symptoms to the weakness, stays confined to the right side. His younger brother has apparently had comparable spells with lights before headaches, although this has never been properly assessed against the specialist weakness criteria that would apply here.