Perfusion patterns in migraine with aura

Förster, Alex; Wenz, Holger; Kerl, H; Brockmann, Marc A.; Groden, Christoph

doi:10.1177/0333102414523339

Cited by 51 publications

(58 citation statements)

References 33 publications

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“…From a methodologic point of view, we excluded the transition parameters (TTP and MTT) from our perfusion analysis. Our findings were in line with those of Förster et al, 32 who demonstrated that perfusion abnormalities in patients with MwA are predominantly substantiated by CBF and CBV changes. TTP analysis of the cerebellar hemispheres is hampered by variant vertebral artery configurations that directly influence the TTP and MTT maps, while no such detrimental effects have been reported for CBF analysis.…”

Section: Discussionsupporting

confidence: 93%

Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance

Kellner-Weldon¹,

El-Koussy²,

Jung

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Patients diagnosed with migraine with aura have an increased lifetime risk of ischemic stroke. It is not yet clear whether prolonged cortical hypoperfusion during an aura increases the immediate risk of cerebellar infarction because it may induce crossed cerebellar diaschisis and subsequent tissue damage. To address this question, we retrospectively analyzed potential relationships between cortical oligemia and cerebellar hypoperfusion in patients with migraine with aura and their potential relation to small infarct-like cerebellar lesions.

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Section: Discussionsupporting

confidence: 93%

Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance

Kellner-Weldon¹,

El-Koussy²,

Jung

et al. 2018

AJNR Am J Neuroradiol

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“…Interestingly, the time course of CBF alterations did not appear to be linked with the persistence of aura symptoms, neither with the persistence of cephalalgia at the time of scanning in our cohort. These findings are in line with previously published works regarding CBF evolution obtained by positron emission tomography MRI or dynamic susceptibility perfusion‐weighted imaging during migraine with aura episodes that suggest that a typical episode begins with decreased regional flows during aura, which eventually increase significantly when the headaches appear. Moreover, our results add to those findings, enlightening the critical effect of the delay between onset and MRI, which seems to be more relevant than the symptoms at the time of imaging study.…”

Section: Discussionsupporting

confidence: 92%

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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“…Discussion.— Aura can persist beyond 4 h in 5% of MWA episodes and brain imaging may sometimes be required in order to properly exclude alternative diagnoses. During the initial phase of a migraine aura, hypo‐perfusion can typically be detected, occasionally extending over multiple vascular territories . A delayed hyper‐perfusion, detectable several hours after the beginning of the migraine and potentially persisting after resolution of the aura, has also been reported .…”

mentioning

confidence: 99%