Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance

F. Kellner-Weldon; M. El-Koussy; S. Jung; M. Jossen; P.P. Klinger-Gratz; R. Wiest

doi:10.3174/ajnr.A5508

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Fig 1.
ROI analysis for perfusion parameters: CER indicates cerebellum; Put, putamen; I, insula; T, thalamus; A, arterial territory of the anterior cerebral artery; M, arterial territory of the middle cerebral artery; P, arterial territory of the posterior cerebral artery; PREC, precentral gyrus; POSTC, postcentral gyrus.
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Fig 2.
CCD in a 14-year-old girl presenting with MwA and CCD. Slices A and C show rCBF images of the infra- and supratentorial brain, and slices B and D, rCBV images respectively. The patient presented with HCH in the right cerebellum with overt hemispheric perfusion asymmetry. Fourteen of 17 supratentorial ROIs in the left supratentorial hemisphere exceeded the AI threshold with lateralization of hypoperfusion contralateral to the cerebellum. Bars indicate relative values for CBV and CBF.

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Table 1:

Clinical characteristics

Predominant Symptom	Abnormal Perfusion		Normal Perfusion
Predominant Symptom	n = 23	%	n = 83	%
Headache	21	91.3	69	57.3
Aura symptoms	22	95.7	76	63.1
Visual	10	43.5	44	36.5
Sensory	17	73.9	37	30.7
Motor	8	34.8	22	18.3
Language	11	47.8	16	13.3

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Table 2:

Predominant clinical symptoms in patients with abnormal cortical perfusion

Predominant Symptom	Patients with Oligemia		HCH (CCD Subgroup)		Non-HCH
Predominant Symptom	n = 23	%	n = 12 (9)	%	n = 11	%
Headache	21	91.3	10 (7)	43.5 (30.4)	11	47.8
Aura symptoms	22	95.7	12 (9)	52.2 (39.1)	10	43.5
Visual	10	43.5	5 (2)	21.7 (8.7)	5	21.7
Sensory	17	73.9	7 (5)	30.4 (21.7)	10	43.5
Motor	8	34.8	4 (4)	17.4 (17.4)	4	17.4
Language	11	47.8	6 (6)	26.1 (26.1)	5	21.7

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Table 3:

The number of ROIs with an AI of > 10% in supratentorial oligemia (maximum, 17 per patient), in the group with hemispheric cerebellar hypoperfusion (154/204) and in the group with symmetric cerebellar perfusion (145/187)

	Abnormal ROIs (AI > 10%)
	Patients with Hemispheric Cerebellar Hypoperfusion (n = 12)	Patients with Symmetric Cerebellar Perfusion (n = 11)
rCBF (No.)
Total No. (%)	154 (75.5)	145 (77.5)
Contralateral	103
Ipsilateral	51
rCBV (No.)
Total No. (%)	155 (75.5)	139 (74.3)
Contralateral	101
Ipsilateral	54

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Table 4:

Mean AI for hypoperfused cerebellar hemisphere and non-HCH (rCBF and rCBV)^{^a}

	AI Absolute Values (%)				P Value
	Group HCH (n = 12)		Group Non-HCH (n = 11)
	Mean	SD	Mean	SD
rCBF supratentorial	27.60	6.85	26.30	6.66	.51
rCBV supratentorial	26.75	6.66	24.64	6.27	.48
rCBF infratentorial	30.56	16.77	4.24	3.23	<.001
rCBV infratentorial	25.69	16.00	4.02	2.53	<.001