RT Journal Article
SR Electronic
T1 Acute-Onset Migrainous Aura Mimicking Acute Stroke: MR Perfusion Imaging Features
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1546
OP 1552
DO 10.3174/ajnr.A3020
VO 33
IS 8
A1 D. Floery
A1 M.R. Vosko
A1 F.A. Fellner
A1 C. Fellner
A1 C. Ginthoer
A1 F. Gruber
A1 G. Ransmayr
A1 A. Doerfler
A1 M. Uder
A1 W.G. Bradley
YR 2012
UL http://www.ajnr.org/content/33/8/1546.abstract
AB BACKGROUND AND PURPOSE: In a very limited number of cases, acute migrainous aura may mimic acute brain infarction. The aim of this study was to recognize patterns of MR perfusion abnormalities in this presentation. MATERIALS AND METHODS: One thousand eight hundred fifty MR imaging studies performed for the suspicion of acute brain infarction were analyzed retrospectively to detect patients with acute migrainous aura not from stroke. All patients were examined clinically by 2 neurologists and underwent a standard stroke MR imaging protocol, including PWI. Two radiologists reviewed the perfusion maps visually and quantitatively for the presence, distribution, and grade of perfusion abnormalities. RESULTS: Among 1850 MR imaging studies, 20 (1.08%) patients were found to have acute migrainous aura. Hypoperfusion was found in 14/20 patients (70%) with delayed rMTT and TTP, decreased rCBF, and minimal decrease in rCBV. In contrast to the typical pattern in stroke, perfusion abnormalities were not limited to a single vascular territory but extended to >1. Bilateral hypoperfusion was seen in 3/14 cases. In 11/14 cases, hypoperfusion with a posterior predominance was found. TTP and rMTT were the best maps to depict perfusion changes at visual assessment, but also rCBF maps demonstrated significant hypoperfusion in quantitative analysis. In all patients, clinical and imaging follow-up findings were negative for stroke. CONCLUSIONS: Acute migrainous aura is rare but important in the differential diagnosis among patients with the suspicion of acute brain infarction. Atypical stroke perfusion abnormalities can be seen in these patients. ACAanterior cerebral arteryPCAposterior cerebral arteryrCBFrelative cerebral blood flowrCBVrelative cerebral blood volumerMTTrelative mean transit time