Migrainous aura as stroke-mimic: The role of perfusion-computed tomography

Ridolfi, Mariana; Granato, Antonio; Polverino, Paola; Furlanis, Giovanni; Ukmar, Maja; Zorzenon, Irene; Manganotti, Paolo

doi:10.1016/j.clineuro.2018.01.032

Cited by 24 publications

(27 citation statements)

References 27 publications

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“…15 Migraine with visual auras may also be associated with hypoperfusion patterns in the occipital cortex that correspond to the affected hemifield, 16 although not all investigators have observed this. 8 Depending on their underlying vascularity, brain tumors may also demonstrate ischemic patterns. In these circumstances, rCBF may be greater secondary to neoangiogenesis, and yet the mean transit time and T max may be delayed.…”

Section: Discussionmentioning

confidence: 99%

“…4 Recently, the DAWN 4 and DEFUSE 3 5 trials showed that automated CTP post-processing algorithms using RAPID (iSchemaView, Inc, Redwood City, CA) can select patients likely to benefit from thrombectomy up to 24 h after onset. Perfusion imaging abnormalities have also been reported to be useful in differentiating stroke mimics from acute ischemic stroke [6][7][8] and may inform treatment decision making. 9 However, the existing literature predominantly consists of small case series and have included only patients with seizures or migraine.…”

Section: Introductionmentioning

confidence: 99%

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Computed tomography perfusion in stroke mimics

Siegler

Rosenberg

Cristancho

et al. 2019

International Journal of Stroke

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Objective To describe the prevalence and patterns of abnormal findings on automated computed tomography perfusion in patients with stroke mimic. Methods We reviewed a retrospective multi-site cohort of consecutive patients undergoing computed tomography perfusion for suspected acute ischemic stroke within 24 h from last normal (June 2017 to December 2017). The primary outcome was the diagnosis of stroke mimic. Hypoperfusion abnormalities on iSchemaView RAPID automated computed tomography perfusion were compared between patients with stroke/transient ischemic attack and stroke mimic using mixed-effects multivariable logistic regression, focusing on absence of perfusion abnormalities and discordance with clinical symptoms and computed tomography angiography findings. Results Of 410 consecutive patients who underwent computed tomography perfusion, 348 met inclusion criteria (178 (51%) stroke, 19 (6%) transient ischemic attack, and 151 (43%) mimic). Time-to-maximum of the tissue residue function (Tmax>6s) abnormalities were seen in 42 (28%) patients with stroke mimic and 122 (62%) patients with stroke/transient ischemic attack ( p < 0.001). Patients with stroke mimic were more likely to have a normal Tmax pattern (volume = 0mL; adjusted OR: 2.2, 95% CI: 1.1–4.3, p = 0.02). When the Tmax pattern was abnormal, a higher proportion of patients with stroke mimic had Tmax patterns fully discordant with clinical symptoms than patients with stroke/transient ischemic attack (28/39 (71%) vs. 10/115 (9%), p < 0.001). Fully discordant Tmax abnormalities were strongly associated with stroke mimic (adjusted OR: 48.6, 95% CI: 7.0–336, p < 0.001), with a negative predictive value for identifying mimic of 91% (95% CI: 85–94%). Conclusion While one-quarter of patients with stroke mimic show Tmax abnormalities on automated RAPID computed tomography perfusion imaging, the majority of patterns were discordant with symptoms and vessel status. Normal or fully discordant Tmax abnormalities are were more common with stroke mimic and may inform stroke treatment decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Computed tomography perfusion in stroke mimics

Siegler

Rosenberg

Cristancho

et al. 2019

International Journal of Stroke

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“…Treat headache symptomatically and consider prophylaxis if recurrences frequent. CTP imaging is normal and can help differentiate from acute stroke [81].…”

Section: Managementmentioning

confidence: 99%

Stroke mimics: incidence, aetiology, clinical features and treatment

et al. 2021

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Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

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“…The actual role of CSD in epilepsy is complex and obscure as data suggest that CSD can predispose to epileptic activity and vice-versa [81]. Migraine aura can be mistaken for a stroke [82, 83] as areas of hypoperfusion can be evidenced during migraine aura. Transient global amnesia (TGA), manifested as a transitory memory loss, could be a manifestation of hippocampal CSD, but may as well be due to a transient ischemic attack or a stroke, and abnormalities in diffusion weighted imaging can be observed due to either etiologies [84], rendering the differential diagnosis even more difficult.…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging clues of migraine aura

Hadjikhani

Vincent

2019

J Headache Pain

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While migraine headaches can be provoked, or predicted by the presence of an aura or premonitory symptoms, the prediction or elicitation of the aura itself is more problematic. Therefore, imaging studies directly examining the aura phenomenon are sparse. There are however interictal imaging studies that can shed light on the pathophysiology of the migraine with aura (MWA) cascade. Here, we review findings pointing to the involvement of cortical spreading depression (CSD) and neuroinflammation in MWA. Whether asymptomatic CSD also happens in some migraine without aura is still under debate. In addition, new evidence points to glial activation in MWA, indicating the involvement of astrocytes in the neuroinflammatory cascade that follows CSD, as well as dural macrophages, supporting the involvement of the trigeminovascular system in migraine pain.

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Migrainous aura as stroke-mimic: The role of perfusion-computed tomography

Cited by 24 publications

References 27 publications

Computed tomography perfusion in stroke mimics

Computed tomography perfusion in stroke mimics

Stroke mimics: incidence, aetiology, clinical features and treatment

Neuroimaging clues of migraine aura

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