Presented at the 2012 AAPM Annual Meeting « Back

Hemispheric Hypoperfusion in Acute Stages of Migraine with Aura

Haley Burke, MD, haley.burke@ucdenver.edu¹, William Jones, MD², (1) University of Colorado School of Medicine, Denver, Colorado, (2) University of Colorado School of Medicine, Aurora, Colorado

Introduction: Migraines often present with focal neurologic deficits in the form of auras. Numerous theories behind migraine pathophysiology exist, including the consideration of hypoperfusion during aura and hyperperfusion during headache. CT perfusion (CTP) imaging is one way to investigate these hypotheses. Case: A 63-year-old man presented to the emergency department with a severe headache, preceded by right-sided neglect and word-finding difficulties. Workup included a non-contrast brain CT and head and neck CT angiogram, which were normal. CTP, completed within 1 hour of symptom onset, demonstrated normal blood volume but prolonged time-to-peak and time-to-onset throughout the left hemisphere. Continuous electroencephalography demonstrated minimal left hemisphere slowing without epileptiform activity. The patient’s neurological deficits resolved over 8 hours. Follow-up brain MRI with diffusion weighted images one day later did not demonstrate acute abnormalities. Discussion: The perfusion deficit involved multiple vascular territories and no significant arterial occlusions or stenoses were identified. Therefore, it was believed that the perfusion deficit was more likely due to migraine than acute stroke. Non-specific slowing of electroencephalographic activity has been reported with migraine. The perfusion deficits were anatomically consistent with the patient’s symptoms of dysphasia and hemineglect. Hemispheric hyperperfusion has been reported with hemiplegic migraine, possibly due to evaluation late after aura onset. Migraine has been infrequently studied with neuro-imaging acutely, and CTP has rarely been used in this regard. This case supports the theory that hypoperfusion may account for migraine and persistent focal deficits. References: 1)Mourand I, Menjot de Champfleur N, et al. Perfusion-weighted MR imaging in persistent hemiplegic migraine. Neuroradiology. 2011 [epub ahead of print]. 2)Asghar M, Hansen A, et al. Evidence for a vascular factor in migraine. Annals of Neurology. 2011;69:635-645.

Funding: None