Migraine Associated Cerebral Hyperperfusion with Arterial Spin-Labeled MR Imaging

Abstract

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...

Acute-Onset Migrainous Aura Mimicking Acute Stroke: MR Perfusion Imaging Features

“…Notably, all except 1 of the cases positive for hypoperfusion also showed changes in rCBF. 21,27 On quantitative analysis, rCBF demonstrated the most pronounced changes, followed by rMTT and TTP. The Spearman correlation test revealed significant correlation for TTP, rMTT, and rCBF between visual and quantitative analysis, except for rCBV.…”

“…16 Some published studies report hyperperfusion; however, this is during the headache stage, 6 -24 hours after the onset of symptoms. 2,17,[19][20][21]24 Others report hypoperfusion during the migrainous aura. 2,14,18,22,23,27 These findings emphasize that early MR imaging examination is crucial to detect the perfusion abnormalities.…”

“…12,13 MR imaging, nuclear medicine, and CT perfusion studies have demonstrated that migrainous aura may be associated with perfusion abnormalities; however, all articles are limited to a small number of selected patients. [14][15][16][17][18][19][20][21][22][23][24] To date, no data are available from a larger series of consecutive patients.…”

Apport de la séquence de marquage des spins artériels (ASL) devant un déficit neurologique brutal et transitoire

“…Pour les patients qui pré sentaient une hyperperfusion corticale non systé matisé e, nous avons conclu au diagnostic d'aura migraineuse, conformé ment aux donné es de la litté rature [8] et à la concordance entre la pré sentation clinique et la localisation de l'hyperperfusion. Notre é tude conforte les travaux pré cé dents sur l'existence d'une hyperperfusion sur la sé quence ASL à distance de l'aura migraineuse [8].…”

“…Notre é tude conforte les travaux pré cé dents sur l'existence d'une hyperperfusion sur la sé quence ASL à distance de l'aura migraineuse [8]. La physiopathologie de l'hyperperfusion dans l'aura migraineuse reste non é lucidé e puisque les é tudes mené es en single photon emission computed tomography (SPECT) avaient jusqu'alors dé crit une baisse modé ré e (de l'ordre de 30 %) du dé bit sanguin cé ré bral aprè s la dé pression corticale envahissante correspondant à l'aura migraineuse [9] L'autre diagnostic envisageable é tait celui d'une hyperperfusion ictale [10].…”