Un mal di testa da mandarti in confusione

The paper reports the case of an 11-year-old girl who presented to the Emergency Room with acute disorientation, agitation, gastrointestinal symptoms and sleep bradypnea. EEG revealed a pathological diffuse slow delta-theta pattern, raising differential diagnoses between acute encephalitis and a migraine equivalent. Following symptomatic treatment and two hours of deep sleep, full neurological recovery was achieved; subsequent brain MRI with ASL perfusion sequences confirmed findings consistent with migraine-related alterations. This case describes acute confusional migraine (ACM), a rare and benign migraine variant presenting with sudden onset of altered consciousness, confusion and agitation. As ACM remains a diagnosis of exclusion - requiring the rule-out of severe neuro-infectious, toxic, or vascular conditions - prompt clinical recognition and neuroimaging are essential to prevent unnecessary invasive procedures.