Magnetic Resonance Angiography Evidence of Vasospasm in Children With Suspected Acute Hemiplegic Migraine

Abstract

Hemiplegic migraine is a rare subtype of migraine that is differentiated by motor weakness in the aura phase. The purpose of this case series was to examine the magnetic resonance angiogram findings of patients suffering from suspected acute hemiplegic migraine. This was a retrospective institutional board review protocol study of 8 patients. All patients received full brain magnetic resonance imaging under a 1.5-T magnet. The scans were subsequently evaluated by a neuroradiologist and 2 neurologists who were blinded to the study. The magnetic resonance angiogram findings of this study showed the presence of vasospasm within the intracranial vasculature during suspected acute hemiplegic migraine. This case series suggests that routine use of magnetic resonance angiography might be beneficial in both managing patients with acute hemiplegic migraine and helping to further understand the pathophysiology of this complicated disease process.

Transient Focal Neurologic Symptoms Correspond to Regional Cerebral Hypoperfusion by MRI: A Stroke Mimic in Children

“…However, in their case series, only the middle cerebral artery was examined. 11 The study by Safier et al did not report on the other branch vessels of the circle of Willis. Consequently, it is not certain whether the vascular changes occurred in only the middle cerebral artery in their patients or if other vessels were similarly affected but not evaluated as part of the study.…”

“…The children had decreased perfusion if scanned Ͻ14 hours from the onset of symptoms, while evidence of increased perfusion was found if imaging was performed at Ͼ17 hours from symptom onset. 10 In addition, Safier et al 11 reported a series of 8 children with hemiplegic migraine who demonstrated vascular narrowing by MRA. However, in their case series, only the middle cerebral artery was examined.…”

Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities

“…As a consequence, childhood AIS is rarely diagnosed within the 4.5 hours window for consideration for intravenous tissue plasminogen activator (tPA) treatment and efforts are much needed on this important issue [29]. Both pre-and post-hospital delays occur with a significant increase in time to diagnosis in outpatients versus inpatients for whom it is still nearly one day… Longer delay has also been associated with posterior circulation stroke, non-abrupt onset, milder or shorter duration symptoms, altered level of consciousness and presentation after working hours [30][31][32][33]. However, some children with large artery occlusion who are not diagnosed within 4.5 hours may theoretically still be eligible for thrombectomy.…”

Magnetic resonance imaging in children presenting migraine with aura: Association of hypoperfusion detected by arterial spin labelling and vasospasm on MR angiography findings

“…These data concord with the hyperperfusion phenomenon described during the headache phase. Data regarding MRA findings in migraine with aura are sparse and limited (8,12). Safier et al.…”

“…Literature studies describing TOF-MRA findings in migraine with aura are rare. A reversible vasospasm has been reported in an 11-year-old girl (11) and more recently in a series of eight children suffering from acute hemiplegic migraine (12).…”