I read with interest the case reported by Chakravarty and
Mukherjee labeled as a migraine variant . They describe a 4
year old boy with delayed expressive language development and
episodic focal motor and language deficits lasting 10 minutes to
3 days. Many inborn errors of metabolism can have such a
presentation in childhood even in the absence of overt changes
on brain magnetic resonance (MR) imaging including organic
acidemias (methylmalonic, propionic and isovaleric), maple syrup
urine disease, ornithine transcarbamylase (OTC) deficiency, and,
hydroxyl-methyl-glutaryl CoA lyase deficiency . Particularly
in boys, OTC deficiency is an important consideration. Lack of
appropriate metabolic investigations to screen for these
disorders and MR spectroscopy, together with absence of headache
in the child, makes the diagnosis doubtful, at best.
Division of Neurology,
Cincinnati Children’s Hospital Medical Center,
1. Chakravarty A, Mukherjee M. Sporadic
hemiplegic migraine. Indian Pediatr. 2012;49:150.
2. Saudubray J-M, Charpentier C. Clinical
Phenotypes: Diagnosis/ Algorithms In: Scriver CR, Sly WS, Childs
B, Beaudet AL, Valle D, Kinzler KW, et al., editors. The
Metabolic and Molecular Bases of Inherited Disease. 8th ed:
McGraw-Hill Professional; 2000.