Time Course of Cerebral Perfusion Changes in Children with Migraine with Aura Mimicking Stroke

Abstract

Hemiplegic migraine is a common cause of acute brain attack in pediatrics. MR imaging sequences useful in differentiating hemiplegic migraine from other entities include arterial spin-labeling, SWI, MRA, and DWI. There has been limited exploration on the simultaneous use of these sequences in pediatrics. We present 12 pediatric patients with acute hemiplegic migraine or migraine with aura who underwent MR imaging within 12 hours of symptom onset. Quantitative and qualitative analyses were performed on arterial spin-labeling; and qualitative analysis, on SWI and MRA sequences. All 12 patients had normal DWI and abnormal arterial spin-labeling findings. Furthermore, we observed a more rapid transition from hypoperfusion to rebound hyperperfusion in 3 patients compared with prior reports. These findings support the use of multimodal MR imaging to distinguish migraine with aura from stroke and the simultaneous use of these MR imaging sequences to improve understanding of perfusion changes during migraine with aura.

Quantification of cerebral veins in patients with acute migraine with aura: A fully automated quantification algorithm using susceptibility-weighted imaging

“…We found a significant association between headache side and the brain hemisphere that visually harboured more PFV. Previous studies have shown that migraine with aura is often associated with unilateral changes in cerebral perfusion which may provoke headache symptoms [7,13]. We believe that the brain hemisphere most affected by these hemodynamic changes on average show more PFV [21] and may therefore represent the clinically affected side.…”

“…We found a negative correlation between time elapsed and the CDH volume. The most likely explanation for this is the time-dependent decrease of deoxygenation of venous cerebral blood throughout the course of MwA, with decreasing conspicuity of the venous vasculature on SWI over time [13,14].…”

Atypical Perfusion Manifestation in Migraine with Aura

“…In 28.6%, it occurs in the rest of the vascular territories [ 2 ], and they can be observed generally during the aura [ 4 ] and in fewer cases during the progression of the headache. The range of time goes from 11 h [ 5 ] up to 12 days, but in all cases, the changes were reversible [ 6 ]. In these latter circumstances, hypoperfusion is regional [ 2 ].…”

Clinical utility of arterial spin labeling imaging in disorders of the nervous system

“…10 One case series of pediatric patients has demonstrated that among ASL, susceptibility weighted imaging, MRA, and diffusion weighted imaging, ASL is the most sensitive in detecting hemiplegic migraine. 5 Therefore, ASL may have utility in differentiating between hemiplegic migraine and stroke. As regards perfusion abnormality, the same study used ASL to demonstrate that initial hypoperfusion in migraine was followed by rebound hyperperfusion.…”

“…As regards perfusion abnormality, the same study used ASL to demonstrate that initial hypoperfusion in migraine was followed by rebound hyperperfusion. 5 Thus, the discrepancy in whether migraine is correlated with hypoperfusion or hyperperfusion may instead be explained by the chronicity of perfusion changes in migraine presentation, as demonstrated by ASL imaging.…”