Acute Confusional Migraine: Unusual Great Masquerader—Case Report and Literature Review

Table 1

The patient’s laboratory test results.

Test (normal range/unit)	Result
WBC (4–11 x 10 ^∧ 3/ul)	H 13.4
RBC (2.8–4.8 x 10 ^∧ 6/ul)	5.1
Hb (12–15 gm/dL)	14.9
Platelets (150–400 x 10 ^∧ 3/ul)	235
Urea (2.7–8 mmol/L)	3.20
Creatinine (44–80 umol/L)	68
Sodium (135–145 mmol/L)	138
Potassium (mmol/L 3.5–5.1)	3.7
Glucose (3.3–5.5 mmol/L)	8.1
ALT (05–5 U/L)	25
AST (04–0 U/L)	25
TSH (0.3–4.2 IU/L)	0.18
Free T3 (3.7–6.4 pmol/L)	5.2
Free T4 (11.6–21.9 pmol/L)	18.8
Acetaminophen (66.0-199.0)	Below level of detection
Ethanol <10,9 mmol/L	<2.2
Salicylate (150–300 mg/L)	Below level of detection
Cholesterol (<5.2 mmol/L)	4.0
Triglyceride (<1.7 mmol/L)	0.5
HDL (>1.0 mmo/L)	0.9
LDL-calc <3.36 mmol/L	2.9 mmol/L
HbA1C % 4.8-5.9	5.6 %
Lactic acid (0.5–2.2 mmol/L)	1.0
CRP (0–5 mg/L)	<5
CSF glucose (2.22–3.89 mmol/L)	3.84
CSF protein (0.15–0.45 gm/L)	0.32
CSF color	Colorless
CSF appearance	Clear
CSF WBC (0–5 uL)	1
CSF RBC (0–2 uL)	460
Protein C activity (70–140%)	73.2%
Protein S activity (72–126%)	96%
Factor V	Negative factor V Leiden mutation
Anticardiolipin ab IgM/IgG	Negative
ANA	Negative

RBCs in the CSF were likely traumatic given the difficulty encountered while performing the lumbar puncture. WBC = white blood cells, RBC = red blood cells, Hb = hemoglobin, ALT = alanine aminotransferase, AST = aspartate aminotransferase, TSH = thyroid stimulating hormone, T3 = triiodothyronine, T4 = thyroxine, HDL = high-density lipoprotein, LDL = low-density lipoprotein, CRP = C-reactive protein, CSF = cerebrospinal fluid.