The pathogenesis of migraine with aura has not been fully established yet. The release of vasoactive substances and intracranial extracerebral blood vessel vasodilatation are probably related to stimulation of meningeal blood vessels through trigeminal afferents. Here, we report a 67 year old woman developing migraine with aphasia and right hemianopsia, lasting 4 days in duration. After spontaneous recovery, she experienced the same symptoms without migraine lasting for 15 h. MRI, performed during this last episode, revealed increased perfusion and leakage of contrast into subarachnoid space. In migraine with prolonged aura hyperperfusion with vasogenic edema might explain cortical function impairment and contribute to neurological deficits.