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

Abstract

Objective A child presenting with a first attack of migraine with aura usually undergoes magnetic resonance imaging (MRI) to rule out stroke. The purpose of this study was to report vascular and brain perfusion findings in children suffering from migraine with aura on time-of-flight MR angiography (TOF-MRA) and MR perfusion imaging using arterial spin labelling (ASL). Methods We retrospectively included all children who had undergone an emergency MRI examination with ASL and TOF-MRA sequences for acute neurological deficit and were given a final diagnosis of migraine with aura. The ASL perfusion maps and TOF-MRA images were independently assessed by reviewers blinded to clinical data. A mean cerebral blood flow (CBF) value was obtained for each cerebral lobe after automatic data post-processing. Results Seventeen children were finally included. Hypoperfusion was identified in one or more cerebral lobes on ASL perfusion maps by visual assessment in 16/17 (94%) children. Vasospasm was noted within the intracranial vasculature on the TOF-MRA images in 12/17 (71%) children. All (100%) of the abnormal TOF-MRA images were associated with homolateral hypoperfusion. Mean CBF values were significantly lower ( P < 0.05) in visually hypoperfused lobes than in normally perfused lobes. Conclusion ASL and TOF-MRA are two totally non-invasive, easy-to-use MRI sequences for children in emergency settings. Hypoperfusion associated with homolateral vasospasm may suggest a diagnosis of migraine with aura.

Magnetic Resonance Imaging in Pediatric Migraine

“…69 Using ASL and MR angiography in retrospective chart analysis, it was found that in pediatric patients with MA, there was homolateral hypoperfusion of the side of vasospasm. 70 A more recent study also using ASL found differences between pediatric migraine patients with and without perfusion changes during migraine. This study has found that patients who had perfusion abnormalities were more likely to have aura, motor disabilities, confusion, and hospitalization.…”

The physiological functions of central nervous system pericytes and a potential role in pain

“…These findings implicate pericytes as key players in pain that arises from altered CBF, for example in migraine and chronic pain conditions associated with altered blood vessel function 63 . Blood oxygen level-dependent technology has linked generalised cerebral hypoperfusion with severe pain in migraineurs, which was associated with concurrent vasospasm 64 . Induced hypoxia worsened pain in response to stimuli designed to invoke an episode.…”

Structural and functional brain changes in perimenopausal women who are susceptible to migraine: a study protocol of multi-modal MRI trial

“…Recently, ASL is an emerging MRI sequence that can be easily performed without contrast injection or any side effects. Some recent studies stressed the significant abnormalities in somatosensory cortex or other brain regions of migraineurs [ 51 , 52 ], while one study declared that they didn’t see and significant changes [ 53 ]. We hope that the impact of the susceptibility of estrogen drop on brain activity could also be reflected in functional imaging.…”