Hemiplegic Migraine in a Patient With Neurologic Symptoms After Regadenoson Administration

Regadenoson, a selective adenosine A2A receptor agonist, is widely used as a stress agent for myocardial perfusion imaging. A2A receptor activation has been implicated in migraines due to its pro-nociceptive effects within trigeminal pain pathways. This case report discusses a 67-year-old female with headache, sudden onset unilateral weakness, and paresthesias after undergoing a PET-CT for ischemic evaluation. Subsequent lab and imaging studies were unconcerning for acute stroke or seizure, raising suspicion for hemiplegic migraine given her extensive neurologic history and rapid onset of symptoms. Regadenoson may be associated with hemodynamic instability and lowering of the seizure threshold. Patients should be screened for neurologic risk factors prior to receiving regadenoson to determine if alternate modalities for ischemic evaluation are more suitable.