Prolonged aphasia and perfusion computed tomography abnormalities in migraine with aura

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Migraine with aura is defined as a recurrent disorder manifesting in attacks of reversible focal neurological symptoms that usually develop gradually, last for less than 60 minutes and is followed by characteristic headache and vegetative symptoms. Acute aphasia is a well-known aura symptom. We present a case of an acute focal neurologic deficit in which perfusion imaging proved helpful in rapid decision making for the appropriate treatment by identifying the syndrome as a stroke mimic. Case Report: A 24-year-old male student was admitted with global aphasia and headache precluding any interview for the patient's medical history. Initial perfusion computed tomography scan showed hypoperfusion in the entire left hemisphere, pronounced in the left occipitotemporal lobe and Broca's area. This pattern which was not restricted to a vascular territory and hypoperfusion above critical ischemia guided us in classifying the deficit as a stroke mimic, specifically as migraine aura. Conclusion:In the hyperacute phase of stroke-like symptoms, multimodal computed tomography scan can add valuable information for differentiating ischemic stroke from stroke mimics and support treatment decision-making.

Solving the conundrum. A migrainous infarction or an infarct-induced migrainous attack?

“…In our case, CT perfusion, performed during progressive neurological symptoms was consistent with a migraine during the aura phase rather than a cerebral infarct, because it showed perfusion changes with hypoperfusion (increased mean transit time) in the left hemisphere (not restricted to any one vascular territory) without significant cerebral blood volume changes. These findings were consistent with the literature data concerning perfusion patterns on CT perfusion[56] but also on MRI perfusion[7] during a migraine with aura attack.…”

Pathophysiological Bases of Comorbidity in Migraine

“…An accurate ophthalmological evaluation, including best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, and indirect ophthalmoscopy, by excluding optical media, retinal, or optic nerve diseases, can help in the differential diagnosis. It has recently been observed that perfusion CT imaging can help in the decision-making process leading to the differential diagnosis of symptoms mimicking a stroke and, therefore, can direct to appropriate treatment (Nieuwkamp et al, 2010 ; Hansen et al, 2011 ; Miller and Goldberg, 2012 ; Campbell et al, 2013 ; Shah et al, 2013 ; Angermaier et al, 2014 ; Rath et al, 2017 ; Ridolfi et al, 2018 ; Granato et al, 2020 ). Diagnostic accuracy can be further improved by refining the diagnostic criteria of transient ischemic attacks, which can help to separate them from mimics (Lebedeva et al, 2018 ; Dolmans et al, 2019 ).…”

Clinical characteristics and perfusion‐computed tomography alterations in a series of patients with migraine with aura attended as stroke code

“…13 A limited number of case reports as well as a short series of patients with MA have reported, in some cases, an abnormal PCT pattern. [14][15][16][17][18][19][20][21] The aim of the current study was to determine the clinical characteristics of MA as well as the frequency and patterns of PCT alterations, in a series of patients with MA mimicking acute ischemic stroke.…”

“…The depolarization wave causes vasodilation and an increase in regional cerebral blood flow (CBF), which has been termed spreading hyperemia, followed by a prolonged period of hypoperfusion lasting 1–2 h, called spreading oligemia 13 . A limited number of case reports as well as a short series of patients with MA have reported, in some cases, an abnormal PCT pattern 14‐21 …”