Advanced MRI study of migrainous infarction presenting as cortical laminar necrosis – Case report and literature review

Morais, Ricardo; Sobral, Filipe; Cunha, Gil; Brito, Olga Martins de; Santana, Isabel

doi:10.1016/j.clineuro.2018.02.016

Cited by 10 publications

(12 citation statements)

References 5 publications

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“…A positron emission tomography study demonstrated a reversible reduction of 40% in cerebral blood flow during a migraine attack that was confirmed bysingle-photon emission computed tomography (SPECT) in a subject with basilar migraine 52,53. Similarly, extensive hypoperfusion of brain regions involved in the development of prolonged aura was reported in another SPECT study27 and in a case of cortical laminar necrosis detected by perfusion MRI 24. Hence, vasoconstrictive drugs such as ergotamines and triptans should be avoided during the acute phase of MI.…”

Section: Discussionmentioning

confidence: 77%

“…Some investigators have explored the biochemical mechanisms underlying MI (Table 2). One group proposed that migraine-related neuronal injury causes glial cell multiplication and accumulation of protein and fat macrophages, which restricts the motion of water molecules in MRI and yields hyperintensities in the T1-weighted image of the affected cerebral region;23 this is supported by a recent report 24. Others have demonstrated cortical hyperexcitability in the primary visual cortex, possibly due to impairment of the γ-aminobutyric acid (GABA)ergic inhibitory network and hypoactivity of thalamo-cortical circuits 25.…”

Section: Systematic Reviewmentioning

confidence: 84%

“…In another patient with MI and vasospasm, a biochemical origin was suggested for the latter based on evidence of enhanced intracellular calcium concentration and vasoactive agents such as serotonin, angiotensin II, hydroperoxides, adenosine diphosphate, and prostaglandins 16Table 2Biochemical Implications Proposed In Migrainous InfarctionMorais et al 201824Deposition of fat laden macrophages, higher protein concentration and glial cell proliferation in the cortical area affectedThissen and Koehler 201425Damage to inhibitory GABAergic cells in the occipital lobe and low cortical preactivation in thalamocortical tractArboix et al 201323Fat macrophages and glial proliferation due to selective neuronal damageSchulz et al 200936Phosphocreatine/inorganic phosphate ratio lower in patients with persistent aura than in Migrainous infarction and controlsLiang and Scott 200726Blood-brain barrier disruption, cytotoxic edema secondary to focal hypermetabolismSolomon et al 199016Intracellular calcium increase, catecholamines and prostaglandins release leading to vasoconstriction …”

Section: Systematic Reviewmentioning

confidence: 99%

See 2 more Smart Citations

<p>Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review</p>

Vinciguerra¹,

Cantone²,

Lanza³

et al. 2019

JPR

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Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5–1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.

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Section: Discussionmentioning

confidence: 77%

Section: Systematic Reviewmentioning

confidence: 84%

Section: Systematic Reviewmentioning

confidence: 99%

See 1 more Smart Citation

<p>Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review</p>

Vinciguerra¹,

Cantone²,

Lanza³

et al. 2019

JPR

View full text Add to dashboard Cite

show abstract

“…Further studies with a larger number of patients will be necessary to explore the prognostic value of ASL in CLN, and evaluate the mismatch with diffusion restriction. 20 Abnormal hypoperfusion on MRI has been reported only in the subacute/chronic phase by Morais et al 21 in a recently published case of migrainous infarction presenting as CLN.…”

Section: Discussionmentioning

confidence: 99%

“…20 Abnormal hypoperfusion on MRI has been reported only in the subacute/chronic phase by Morais et al. 21 in a recently published case of migrainous infarction presenting as CLN. The MRI examination performed one month after the migraine attack showed a cortical-based gyriform lesion, with hyperintensity on T1-weighted imaging and cortical enhancement after contrast administration associated with hypoperfusion on perfusion-weighted imaging (PWI) and the absence of activation of the injured cortex on functional MRI.…”

Section: Discussionmentioning

confidence: 99%

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

Cannella

Sparacia

et al. 2019

Neuroradiol J

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Purpose The aim of this study was to assess the novel advanced magnetic resonance imaging findings of acute stage cortical laminar necrosis developing after complicated cardiovascular or abdominal surgery. Materials and methods This institutional review board-approved study included patients with postoperative stroke due to cortical laminar necrosis imaged with magnetic resonance in the acute stage. Brain magnetic resonance imaging examinations were obtained on a 3T magnetic resonance scanner within 48 hours of the neurological symptoms, including diffusion-weighted images (b value, 1000 s/mm2) and arterial spin labelling using a pseudo-continuous arterial spin labelling method in four patients. Conventional and advanced magnetic resonance images were analysed to assess the imaging features in acute stage cortical laminar necrosis. Results The final population consisted of 14 patients (seven men and seven women, mean age 61 years, range 32–79 years) diagnosed with stroke and acute phase cortical laminar necrosis. All the patients presented with cortical lesions showing restricted diffusion on diffusion-weighted images and hypointensity on the apparent diffusion coefficient map. Cortical hyperintensity on T2-weighted or fluid-attenuated inversion recovery images was found in three (21%) and six (43%) patients, respectively. Reduced perfusion was noted in three out of four patients imaged with arterial spin labelling, while in one case no corresponding perfusion abnormality was noted on the arterial spin labelling maps. Arterial spin labelling abnormalities were much more extensive than diffusion restriction in two patients, and they were associated with a poor outcome. Conclusion Cortical hyperintense abnormalities on diffusion-weighted imaging may be the only sign of developing cortical laminar necrosis injury. The acquisition of arterial spin labelling helps to identify perfusion alterations and the extension of the ischaemic injury.

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Ultrafast power Doppler imaging for ischemic encephalopathy: A case report

Huang,

Jiao,

et al. 2023

World J Clin Cases

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Type 2 diabetes mellitus (T2DM), which is distinguished by increased glucose levels in the bloodstream, is a metabolic disease with a rapidly increasing incidence worldwide. Nevertheless, the etiology and characteristics of the mechanism of T2DM remain unclear. Recently, abundant evidence has indicated that the intestinal microbiota is crucially involved in the initiation and progression of T2DM. The gut microbiome, the largest microecosystem, engages in material and energy metabolism in the human body. In this review, we concentrated on the correlation between the gut flora and T2DM. Meanwhile, we summarized the pathogenesis involving the intestinal flora in T2DM, as well as therapeutic approaches aimed at modulating the gut microbiota for the management of T2DM. Through the analysis presented here, we draw attention to further exploration of these research directions.

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Advanced MRI study of migrainous infarction presenting as cortical laminar necrosis – Case report and literature review

Cited by 10 publications

References 5 publications

<p>Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review</p>

<p>Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review</p>

Advanced magnetic resonance imaging of cortical laminar necrosis in patients with stroke

Ultrafast power Doppler imaging for ischemic encephalopathy: A case report

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