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Perfusion-weighted MR imaging in persistent hemiplegic migraine

  • Functional Neuroradiology
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Abstract

Introduction

Hemiplegic migraine is a rare type of migraine that has an aura characterized by the presence of motor weakness, which may occasionally last up to several days, and then resolve without sequela. Pathogenesis of migraine remains unclear and, recently, perfusion-weighted imaging (PWI) has provided a non-invasive method to study hemodynamic changes during acute attacks.

Methods

Two female patients were admitted in our hospital suffering from prolonged hemiparesis. In both cases, they underwent MRI examination using a 1.5 T magnet including axial diffusion-weighted and perfusion sequences. From each perfusion MRI acquisition two regions of interest were delineated on each hemisphere and, the index of flow, cerebral blood volume, mean transit time, and time to peak were recorded and asymmetry indices from each perfusion parameter were calculated.

Results

Perfusion alterations were detected during the attacks. In one case, we observed, after 3 h of left hemiparesia, hypoperfusion of the right hemisphere. In the other case, who presented a familial hemiplegic migraine attack, on the third day of a persistent aura consisting of right hemiplegia and aphasia, PWI revealed hyperperfusion of the left hemisphere. Asymmetry indices for temporal parameters (mean transit time and time to peak) were the most sensitive. These findings resolved spontaneously after the attacks without any permanent sequel or signs of cerebral ischemia on follow-up MRI.

Conclusions

PWI should be indicated for patients with migraine attacks accompanied by auras to assess the sequential changes in cerebral perfusion and to better understand its pathogenesis.

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Abbreviations

PWI:

perfusion-weighted imaging

HM:

Hemiplegic migraine

FHM:

familial hemiplegic migraine

SHM:

sporadic hemiplegic migraine

DWI:

diffusion-weighted imaging

CBV:

cerebral blood volume

FLAIR:

fluid-attenuated inversion recovery

ICBF:

Index of Cerebral Blood Flow

MTT:

mean transit time

TTP:

time to peak

TOF:

3D time-of-flight

MRA:

MR angiography

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We declare that we have no conflict of interest.

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Correspondence to Isabelle Mourand.

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Mourand, I., Menjot de Champfleur, N., Carra-Dallière, C. et al. Perfusion-weighted MR imaging in persistent hemiplegic migraine. Neuroradiology 54, 255–260 (2012). https://doi.org/10.1007/s00234-011-0946-z

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  • DOI: https://doi.org/10.1007/s00234-011-0946-z

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