Pediatric hemiplegic migraine: Role of multiple MRI techniques in evaluation of reversible hypoperfusion

Bosemani, Thangamadhan; Burton, Vera Joanna; Felling, Ryan J.; Leigh, R. John; Oakley, Christopher; Poretti, Andrea; Huisman, Thierry A.G.M.

doi:10.1177/0333102413509432

Cited by 36 publications

(27 citation statements)

References 22 publications

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“…While the pathophysiology of these events is not fully understood, and likely differs by subtype, recent works are paving the way towards a better understanding of the mechanisms involved. 6,10,11,19 The duration of symptoms in our cohort was strikingly long for migraine with aura (especially aura, with a median of 4h), reflecting the specificity of these atypical events that misled the initial clinical assessment and eventually led to advanced brain imaging. ASL mapped CBF regional alterations provided critical elements for the positive and differential diagnosis at the acute phase.…”

Section: Discussionmentioning

confidence: 92%

“…Of note, the duration of hypoperfusion (up to 14h) also appeared to be strikingly long as compared with previous literature, also accounting for the specificity of these atypical events. While the pathophysiology of these events is not fully understood, and likely differs by subtype, recent works are paving the way towards a better understanding of the mechanisms involved …”

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance imaging arterial‐spin‐labelling perfusion alterations in childhood migraine with atypical aura: a case–control study

Boulouis

Shotar

Dangouloff‐Ros

et al. 2016

Develop Med Child Neuro

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ASLArterial-spin-labelling CBF Cerebral blood flow DWI Diffusion-weighted imaging ROI Region of interest AIM Atypical migraine with aura can be challenging to diagnose. Arterial-spin-labelling (ASL)is able to non-invasively quantify brain perfusion. Our aim was to report cerebral blood flow (CBF) alterations using ASL, at the acute phase of atypical migraine with aura in children.METHOD Paediatric patients were retrospectively included if (1) referred for acute neurological deficit(s), (2) underwent brain magnetic resonance imaging (MRI) at presentation with ASL sequence, and (3) had subsequent diagnosis of migraine with aura. Neurological symptom-free controls were matched for age. Twenty-eight regions of interest (ROIs) were drawn on CBF maps for each participant/control. RESULTSTen patients were included (median age 13y, range 8-16y). Eight of 10 had multiple aura symptoms during the episode. For every patient, CBF was decreased in a brain region consistent with symptoms when MRI was performed less than 14 hours after onset (n=7 patients) and increased if the MRI was performed 17 hours or more after (n=4 MRIs).INTERPRETATION MRI-ASL appears to be a promising tool for the diagnostic workup and differentials exclusion in paediatric migraine with aura. Constant and time-consistent nonterritorial CBF modifications were found in our sample providing additional insight to migraine with aura pathophysiology. The authors encourage implementing this sequence at the acute phase of unexplained paediatric neurological deficits, with or without accompanying headache.Atypical presentations of migraine with aura can be difficult to diagnose and can be mistaken for acute stroke. 1,2 Typical aura is a fully reversible visual, sensory, motor, or phasic symptom, developing gradually over 5 minutes, lasting less than an hour per symptom, and accompanied or followed by headache within 60 minutes from symptom resolution. With a prevalence ranging from 3% in 3-to 7-year-old children to 8% to 20% in adolescents, 4 migraine is a common headache syndrome in the paediatric population. Up to 30% of patients report a preceding aura 5 and significant variations of symptoms expression over the span of childhood make migraine with aura a really challenging diagnostic situation, especially for atypical auras. To date, atypical migraine with aura pathophysiology remains elusive. Aura results from neurovascular phenomena comprising cortical spreading depression associated with cerebral regional hypoperfusion accompanied by negative neurological features. Subsequent neuronal hyperpolarization and regional hyperperfusion are concurrent with cephalalgia.6 Several cases and case-series have reported these perfusion modifications in adults, 1,[7][8][9][10] but literature regarding migraine with aura in children remains scant.Structural neuroimaging (including T1, T2, and fluidattenuated inversion recovery) findings in paediatric migraine patients are meagre and largely unspecific. On the other hand, more advanced magnetic resonance imaging (MRI) te...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging arterial‐spin‐labelling perfusion alterations in childhood migraine with atypical aura: a case–control study

Boulouis

Shotar

Dangouloff‐Ros

et al. 2016

Develop Med Child Neuro

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“…Focusing on cortical veins in SWI, their prominent and dark appearance has been described in stroke patients in perfusion-disturbed regions after thromboembolic occlusion [17,18,20,21], owing to increased deoxyhaemoglobin levels, secondary to an increased extraction fraction of oxygen by the ischemic parenchyma. Further, prominent-appearing cortical veins have been described in patients with hemiplegic migraine correlating with hypoperfusion [22,23]. Since focal parenchymal areas are expected to be hyperperfused during seizure activity, an opposite effect with correlating pseudo-narrowing of cortical veins would be expected in case of a lower deoxyhaemoglobin content, and therefore decreased paramagnetic properties.…”

Section: Introductionmentioning

confidence: 99%

Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI)

et al. 2014

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“…This disorder usually has a familial autosomal dominant inheritance trait but, like our patient, can be sporadic. An MRI can show cortical edema, with sulcal hyperintensity on FLAIR (Figure), this being rare and of uncertain etiology, possibly due to increased vascular permeability during the aura phase mimicking subarachnoid hemorrhage 1,2,3 . …”

mentioning

confidence: 99%

Sulcal hyperintensity mimicking subarachnoid hemorrhage in the context of hemiplegic migraine

Batista

Júnior

Muniz

2017

Arq. Neuro-Psiquiatr.

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Pediatric hemiplegic migraine: Role of multiple MRI techniques in evaluation of reversible hypoperfusion

Abstract: Multiple conventional and advanced MRI techniques including SWI play a key role in an HM attack to (1) exclude acute arterial ischemic stroke and (2) further understand the pathophysiology of HM.

Cited by 36 publications

References 22 publications

Magnetic resonance imaging arterial‐spin‐labelling perfusion alterations in childhood migraine with atypical aura: a case–control study

Magnetic resonance imaging arterial‐spin‐labelling perfusion alterations in childhood migraine with atypical aura: a case–control study

Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI)

Sulcal hyperintensity mimicking subarachnoid hemorrhage in the context of hemiplegic migraine

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