Imaging Abnormalities in Sporadic Hemiplegic Migraine on Conventional MRI, Diffusion and Perfusion MRI and MRS

Jacob, Anu; Mahavish, K; Bowden, A. N.; Smith, Elizabeth; Enevoldson, Peter; White, Richard P.

doi:10.1111/j.1468-2982.2006.01131.x

Cited by 51 publications

(53 citation statements)

References 17 publications

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“…The hypothesis of a mitochondrial deficiency was also put forward by a study in which decreased NAA was found in the (left) thalamus of MwoA patients (36). Finally, a reduced NAA concentration was also found at rest in the cerebellum of FHM1 patients (37), in the left temporoparietal cortex (site of migrainous stroke) of a sporadic hemiplegic migraine (SHM) patient (38) and in the occipital cortex of another SHM patient (39), which has been rather attributed to neuronal impairment or loss. The latter is obvious in migrainous stroke but may also fit with the frequently observed cerebellar atrophy in FHM (40).…”

Section: Naamentioning

confidence: 93%

“…It is possible that the signal-to-noise ratio, in particular in 31 (11,12). In a few studies information concerning coil specification was lacking (37)(38)(39)49). Table 4 describes which MRS localization technique was used in each study.…”

Section: Magnetic Field Strength and Coilsmentioning

confidence: 99%

“…Information regarding signal estimation was not reported in the remaining studies (27,28,38,39,49,54).…”

Section: Signal Processingmentioning

confidence: 99%

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Magnetic resonance spectroscopy in migraine: What have we learned so far?

2012

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Objective: To summarize and evaluate proton (1H) and phosphorus (31P) magnetic resonance spectroscopy (MRS) findings in migraine. Methods: A thorough review of 1H and/or 31P-MRS studies in any form of migraine published up to September 2011. Results: Some findings were consistent in all studies, such as a lack of ictal/interictal brain pH change and a disturbed energy metabolism, the latter of which is reflected in a drop in phosphocreatine content, both in the resting brain and in muscle following exercise. In a recent interictal study ATP was found to be significantly decreased in the occipital lobe of migraine with aura patients, reinforcing the concept of a mitochondrial component to the migraine threshold, at least in a subgroup of patients. In several studies a correlation between the extent of the energy disturbance and the clinical phenotype severity was apparent. Less consistent but still congruent with a disturbed energy metabolism is an observed lactate increase in the occipital cortex of several migraine subtypes (MwA, migraine with prolonged aura). No increases in brain glutamate levels were found. Conclusion: The combined abnormalities found in MRS studies imply a mitochondrial component in migraine neurobiology. This could be due to a primary mitochondrial dysfunction or be secondary to, for example, alterations in brain excitability. The extent of variation in the data can be attributed to both the variable clinical inclusion criteria used and the variation in applied methodology. Therefore it is necessary to continue to optimize MRS methodology to gain further insights, especially concerning lactate and glutamate.

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Section: Naamentioning

confidence: 93%

Section: Magnetic Field Strength and Coilsmentioning

confidence: 99%

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Magnetic resonance spectroscopy in migraine: What have we learned so far?

2012

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“…3,11 DSC and nuclear medicine studies have shown postaura hyperperfusion in the cortex affected by the hemiplegic migraine. 3,11,[36][37][38] As opposed to ASL, nuclear medicine studies and contrast bolus techniques are not easily repeatable, require radiopharmaceuticals that must be prepared in advance, and can require multi-day examinations to avoid double dosing.…”

Section: 28mentioning

confidence: 99%

Migraine Associated Cerebral Hyperperfusion with Arterial Spin-Labeled MR Imaging

Pollock¹,

Deibler²,

Burdette³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:We present a case series demonstrating abnormal regional cerebral hyperperfusion associated with migraine headache using arterial spin-labeling (ASL). In 3 of 11 patients, regional cortical hyperperfusion was demonstrated during a headache episode that corresponded to previous aura symptoms. Migraine is a common condition affecting 12% of the United States population per year.1 Migraines classically present with unilateral debilitating, painful headaches associated with photophobia, phonophobia, nausea, and vomiting. Less than 30% of migraines are preceded by auras, or focal neurologic deficits. Most commonly, the neurologic deficits are visual, but sensory and motor deficits can also occur. The pathophysiology of a migraine is complex and is not completely understood. The vascular theory proposes that the migraine aura is associated with vasoconstriction and the subsequent headache is associated with vasodilation and hyperperfusion.3,4 The second theory is that a contiguous wave of neuronal depression spreads through the cortex causing the aura symptoms.5-10 The vascular changes have been evaluated with nuclear medicine studies including single-photon emission CT and positron-emission tomography as well as blood oxygen level-dependent functional MR imaging and T2* dynamic susceptibility contrast (DSC) MR perfusion imaging. 3,8,9,[11][12][13] These methods are limited in the evaluation of the patient with migraine because of the dynamic nature of the perfusion abnormalities.Spin tag perfusion imaging is an MR imaging method that measures quantitative cerebral blood flow (CBF).14 The advantages of arterial spin-labeling (ASL) compared with conventional perfusion techniques include repeatability, absolute quantification, and the avoidance of intravenous contrast administration. 15,16 We performed a retrospective analysis of MR imaging examinations including ASL perfusion in patients with an indication of headache from the past 12 months and identified 11 clinical patients with a history of migraine headache. We present the 3 patients with migraine-associated regional cerebral hyperperfusion corresponding to the clinical presentation. Case Reports Patient 1A 55-year-old woman with a history of hemiplegic migraines presented with new-onset right frontal headache, left-sided numbness, weakness, and dysarthria. The patient took prochlorperazine (Compazine) at home without relief of her symptoms. We performed cerebral MR imaging 6 hours after onset of symptoms using our standard stroke protocol including conventional sequences and ASL perfusion. Conventional MR imaging sequences demonstrated subtle sulcal effacement and mild edema in the right frontal cortex without evidence of diffusion abnormality (Fig 1).We generated quantitative CBF maps using quantitative imaging of perfusion and a single subtraction with thin-section inversion time (TI) 1 periodic saturation with a flow-sensitive alternating inversion recovery sequence as described previously.17 This sequence generates 60 tag and control image pairs. Imag...

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“…Spectroscopy study showed reduced NAA/Cr. To explain these results, in the absence of vascular occlusion, the authors suggested a metabolic alteration at cellular level with a spreading cortical depression leading to damage of the ATPase pump with altered membrane permeability [45].…”

Section: Migraine With Auramentioning

confidence: 99%

Neuroradiology and headaches

2006

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Headache is one of the most common outpatient pain conditions encountered in both physician offices and emergency departments. Establishment of an accurate diagnosis, accomplished only by a thorough history followed by a physical examination, is critical before treatment can be initiated. Many patients undergo evaluation with computed tomography and more recently magnetic resonance imaging to exclude important abnormalities. It is known that a little percentage of patients showed significant neuroradiologiacal abnormalities and the rate of significant intracranial abnormalities in patients with headache and normal neurological examination exists.

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Imaging Abnormalities in Sporadic Hemiplegic Migraine on Conventional MRI, Diffusion and Perfusion MRI and MRS

Cited by 51 publications

References 17 publications

Magnetic resonance spectroscopy in migraine: What have we learned so far?

Magnetic resonance spectroscopy in migraine: What have we learned so far?

Migraine Associated Cerebral Hyperperfusion with Arterial Spin-Labeled MR Imaging

Neuroradiology and headaches

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