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Riederer F, Beiersdorf J, Lang C, Pirker-Kees A, Klein A, Scutelnic A, Platho-Elwischger K, Baumgartner C, Dreier JP, Schankin C. Signatures of migraine aura in high-density-EEG. Clin Neurophysiol 2024; 160:113-120. [PMID: 38422969 DOI: 10.1016/j.clinph.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Cortical spreading depolarization is highly conserved among the species. It is easily detectable in direct cortical surface recordings and has been recorded in the cortex of humans with severe neurological disease. It is considered the pathophysiological correlate of human migraine aura, but direct electrophysiological evidence is still missing. As signatures of cortical spreading depolarization have been recognized in scalp EEG, we investigated typical spontaneous migraine aura, using full band high-density EEG (HD-EEG). METHODS In this prospective study, patients with migraine with aura were investigated during spontaneous migraine aura and interictally. Time compressed HD-EEG were analyzed for the presence of cortical spreading depolarization characterized by (a) slow potential changes below 0.05 Hz, (b) suppression of faster activity from 0.5 Hz - 45 Hz (c) spreading of these changes to neighboring regions during the aura phase. Further, topographical changes in alpha-power spectral density (8-14 Hz) during aura were analyzed. RESULTS In total, 26 HD-EEGs were recorded in patients with migraine with aura, thereof 10 HD-EEGs during aura. Eight HD-EEGs were recorded in the same subject. During aura, no slow potentials were recorded, but alpha-power was significantly decreased in parieto-occipito-temporal location on the hemisphere contralateral to visual aura, lasting into the headache phase. Interictal alpha-power in patients with migraine with aura did not differ significantly from age- and sex-matched healthy controls. CONCLUSIONS Unequivocal signatures of spreading depolarization were not recorded with EEG on the intact scalp in migraine. The decrease in alpha-power contralateral to predominant visual symptoms is consistent with focal depression of spontaneous brain activity as a consequence of cortical spreading depolarization but is not specific thereof. SIGNIFICANCE Cortical spreading depolarization is relevant in migraine, other paroxysmal neurological disorders and neurointensive care.
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Affiliation(s)
- Franz Riederer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; University of Zurich, Medical Faculty, Zurich, Switzerland.
| | - Johannes Beiersdorf
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology
| | - Clemens Lang
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology; Department of Neurology, Clinic Hietzing, Vienna, Austria
| | - Agnes Pirker-Kees
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology; Department of Neurology, Clinic Hietzing, Vienna, Austria
| | - Antonia Klein
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kirsten Platho-Elwischger
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology; Department of Neurology, Clinic Hietzing, Vienna, Austria
| | - Christoph Baumgartner
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology; Department of Neurology, Clinic Hietzing, Vienna, Austria
| | - Jens P Dreier
- Department of Neurology and Experimental Neurology Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Riederer F, Beiersdorf J, Scutelnic A, Schankin CJ. Migraine Aura-Catch Me If You Can with EEG and MRI-A Narrative Review. Diagnostics (Basel) 2023; 13:2844. [PMID: 37685382 PMCID: PMC10486733 DOI: 10.3390/diagnostics13172844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Roughly one-third of migraine patients suffer from migraine with aura, characterized by transient focal neurological symptoms or signs such as visual disturbance, sensory abnormalities, speech problems, or paresis in association with the headache attack. Migraine with aura is associated with an increased risk for stroke, epilepsy, and with anxiety disorder. Diagnosis of migraine with aura sometimes requires exclusion of secondary causes if neurological deficits present for the first time or are atypical. It was the aim of this review to summarize EEG an MRI findings during migraine aura in the context of pathophysiological concepts. This is a narrative review based on a systematic literature search. During visual auras, EEG showed no consistent abnormalities related to aura, although transient focal slowing in occipital regions has been observed in quantitative studies. In contrast, in familial hemiplegic migraine (FHM) and migraine with brain stem aura, significant EEG abnormalities have been described consistently, including slowing over the affected hemisphere or bilaterally or suppression of EEG activity. Epileptiform potentials in FHM are most likely attributable to associated epilepsy. The initial perfusion change during migraine aura is probably a short lasting hyperperfusion. Subsequently, perfusion MRI has consistently demonstrated cerebral hypoperfusion usually not restricted to one vascular territory, sometimes associated with vasoconstriction of peripheral arteries, particularly in pediatric patients, and rebound hyperperfusion in later phases. An emerging potential MRI signature of migraine aura is the appearance of dilated veins in susceptibility-weighted imaging, which may point towards the cortical regions related to aura symptoms ("index vein"). Conclusions: Cortical spreading depression (CSD) cannot be directly visualized but there are probable consequences thereof that can be captured Non-invasive detection of CSD is probably very challenging in migraine. Future perspectives will be elaborated based on the studies summarized.
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Affiliation(s)
- Franz Riederer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland (C.J.S.)
- Department of Neurology, University Hospital Zurich, Medical Faculty, University of Zurich, CH 8091 Zurich, Switzerland
| | - Johannes Beiersdorf
- Karl Landsteiner Institute for Clinical Epilepsy Reserach and Cognitive Neurology, AT 1130 Vienna, Austria;
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland (C.J.S.)
| | - Christoph J. Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland (C.J.S.)
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Jicha CJ, Alex A, Herskovitz S, Haut SR, Lipton R. Migraine with prolonged aphasic aura associated with a CACNA1A mutation: A case report and narrative review. Headache 2023. [PMID: 37366229 DOI: 10.1111/head.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To demonstrate that a known CACNA1A variant is associated with a phenotype of prolonged aphasic aura without hemiparesis. BACKGROUND The usual differential diagnosis of prolonged aphasia without hemiparesis includes vascular disease, seizure, metabolic derangements, and migraine. Genetic mutations in the CACNA1A gene can lead to a myriad of phenotypes, including familial hemiplegic migraine (FHM) type 1, an autosomal dominant disorder characterized by an aura of unilateral, sometimes prolonged weakness. Though aphasia is a common feature of migraine aura, with or without hemiparesis, aphasia without hemiparesis has not been reported with CACNA1A mutations. METHODS We report the case of a 51-year-old male who presented with a history of recurrent episodes of aphasia without hemiparesis lasting days to weeks. His headache was left sided and was heralded by what his family described as "confusion." On examination, he had global aphasia without other focal findings. Family history revealed several relatives with a history of severe headaches with neurologic deficits including aphasia and/or weakness. Imaging revealed T2 hyperintensities in the left parietal/temporal/occipital regions on MRI scan with corresponding hyperperfusion on SPECT. Genetic testing revealed a missense mutation in the CACNA1A gene. CONCLUSIONS This case expands the phenotypic spectrum of the CACNA1A mutation and FHM to include prolonged aphasic aura without hemiparesis. Our patient's SPECT imaging demonstrated hyperperfusion in areas correlating with aura symptoms which can occur in prolonged aura.
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Affiliation(s)
- Crystal J Jicha
- Department of Neurology, University of California Irvine, Irvine, California, USA
| | - Ashley Alex
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, The State University of New York, Buffalo, New York, USA
| | - Steven Herskovitz
- Department of Neurology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Sheryl R Haut
- Saul R. Korey Department of Neurology, Montefiore Epilepsy Center, Bronx, New York, USA
| | - Richard Lipton
- Department of Neurology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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4
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Han MJ, Park SY, Hwang S, Kim SJ. Clinical significance of asymmetric hypointense signals in minimum intensity projections of brain magnetic resonance imaging in children with primary headache. Neuroradiology 2023; 65:415-422. [PMID: 36319857 DOI: 10.1007/s00234-022-03076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE This study aimed to observe the changes of venous continuity using the susceptibility weighted imaging-minimum intensity projection (SWI-MinIP) images in children with primary headache. METHODS The headache types were classified following the International Headache Society's diagnostic criteria. Patients with secondary headaches were excluded. The presence of asymmetric vasculature in SWI-MinIP images was visually assessed. Moreover, the relationship between headache patterns and asymmetric hypointense signals was analyzed. RESULTS In this single-center, retrospective study from 2016 to 2020, among 251 cases of primary headache (male/female, 108/143; mean age, 11.4 ± 4.0 years), 137 (54.6%), 75 (29.9%), and 39 (15.5%) patients had migraine, tension-type headache, and other primary headaches, respectively. On SWI-MinIP images, 14 (5.6%) patients showed an asymmetric venous pattern. All patients with SWI-MinIP asymmetry were included in the migraine group, accounting for 10.2% of patients with migraine. Five (35.7%) and nine (64.3%) patients were included in the aura and non-aura groups, respectively, without a significant difference in the frequency of asymmetric hypointense signals between the two groups (p = 0.325). All 14 patients with asymmetric hypervascularity had brain MRI within 12 h of headache onset. Ten (71.4%) of the 14 patients showed consistency between the laterality of headache and the hemisphere of predominant vascularity in SWI-MinIP. CONCLUSION Patients with migraine had increased cerebral venous perfusion in the most involved region of the headache on the SWI-MinIP view on a 3.0 T scanner, which can be used as a qualitative indicator with low sensitivity and high specificity for the diagnosis of primary headache in the acute phase (< 12 h).
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Affiliation(s)
- Min Jeong Han
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea.,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea
| | - So Yeon Park
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea
| | - Seungbae Hwang
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea.,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea.,Department of Radiology, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea. .,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea. .,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonbuk, 54907, Korea.
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5
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Suwanwela NC, Kijpaisalratana N, Tepmongkol S, Rattanawong W, Vorasayan P, Charnnarong C, Tantivattana J, Roongruang S, Ongphichetmetha T, Panjasriprakarn P, Chutinet A, Akarathanawat W, Saver JL. Prolonged migraine aura resembling ischemic stroke following CoronaVac vaccination: an extended case series. J Headache Pain 2022; 23:13. [PMID: 35062869 PMCID: PMC8777408 DOI: 10.1186/s10194-022-01385-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background After the initiation of the COVID-19 vaccination program in Thailand, thousands of patients have experienced unusual focal neurological symptoms. We report 8 patients with focal neurological symptoms after receiving inactivated virus vaccine, CoronaVac. Case series Patients were aged 24–48 years and 75% were female. Acute onset of focal neurological symptoms occurred within the first 24 h after vaccination in 75% and between 1-7d in 25%. All presented with lateralized sensory deficits, motor deficits, or both, of 2–14 day duration. Migraine headache occurred in half of the patients. Magnetic resonance imaging of the brain during and after the attacks did not demonstrate any abnormalities suggesting ischemic stroke. All patients showed moderately large regions of hypoperfusion and concurrent smaller regions of hyperperfusion on SPECT imaging while symptomatic. None developed permanent deficits or structural brain injury. Discussions Here, we present a case series of transient focal neurological syndrome following Coronavac vaccination. The characteristic sensory symptoms, history of migraine, female predominant, and abnormal functional brain imaging without structural changes suggest migraine aura as pathophysiology. We propose that pain related to vaccine injection, component of vaccine, such as aluminum, or inflammation related to vaccination might trigger migraine aura in susceptible patients. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01385-0.
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Gonzalez-Martinez A, Trillo Senín S, Benavides Bernaldo de Queirós C, Casado Fernández L, Barbosa Del Olmo A, Manzanares López R, Gago-Veiga AB, Vivancos J. Clinical characteristics and perfusion-computed tomography alterations in a series of patients with migraine with aura attended as stroke code. Headache 2021; 61:1568-1574. [PMID: 34862603 DOI: 10.1111/head.14243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of the current study was to determine the clinical characteristics of migraine with aura (MA) as well as the frequency and patterns of perfusion-computed tomography (PCT) alterations, in a series of patients with MA mimicking acute ischemic stroke. BACKGROUND MA is one of the most frequent stroke mimics, following seizures and psychiatric disorders. Previous case reports and short series have reported abnormal PCT patterns in patients with MA. METHODS We conducted a retrospective cohort study including all consecutive patients presenting with focal neurological symptoms during complete multimodal CT including baseline CT, angio-CT, and PCT with a final diagnosis of MA. We collected demographic data and clinical information about MA variables using the hospital electronic database. RESULTS We found 25 patients with a final diagnosis of MA among 1761 patients who attended our stroke center with complete multimodal CT (1.4% [95% CI: 0.9-2.1]). Among them, 14/25 (56%) were women, average age 38.7 years (SD 12.5), and 16/25 (64%) had a previous history of migraine. The most frequent type of aura was sensory. The median time elapsed between the onset of symptoms and CT was 171 min (IQR: 119-244). PCT alteration was found in 3/25 (12%) consisting of a hypoperfusion pattern not restricted to a vascular territory. The three patients had aphasia as the presenting symptom. CONCLUSION This is, to the best of our knowledge, the largest series of patients with MA managed as presumed stroke with clinical characteristics and PCT. In our study, most patients were young and had a prior history of migraine. PCT was normal in 88% of cases, with patients being still symptomatic by the time they were scanned. Further research will clarify the presence and type of PCT alterations in this entity.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Santiago Trillo Senín
- Stroke Unit, Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | | - Laura Casado Fernández
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Antonio Barbosa Del Olmo
- Department of Neuroradiology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Rafael Manzanares López
- Department of Neuroradiology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - José Vivancos
- Stroke Unit, Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
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Zhang D, Huang X, Mao C, Chen Y, Miao Z, Liu C, Xu C, Wu X, Yin X. Assessment of normalized cerebral blood flow and its connectivity with migraines without aura during interictal periods by arterial spin labeling. J Headache Pain 2021; 22:72. [PMID: 34261444 PMCID: PMC8278584 DOI: 10.1186/s10194-021-01282-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migraine constitutes a global health burden, and its pathophysiology is not well-understood; research evaluating cerebral perfusion and altered blood flow between brain areas using non-invasive imaging techniques, such as arterial spin labeling, have been scarce. This study aimed to assess cerebral blood flow (CBF) and its connectivity of migraine. METHODS This study enrolled 40 patients with episodic migraine without aura (MwoA), as well as 42 healthy patients as control (HC). Two groups of normalized CBF and CBF connectivity were compared, and the relationship between CBF variation and clinical scale assessment was further evaluated. RESULTS In comparison to HC subjects, MwoA patients exhibited higher CBF in the right middle frontal orbital gyrus (ORBmid.R) and the right middle frontal gyrus, while that in Vermis_6 declined. The increased CBF of ORBmid.R was positively correlated with both the Visual Light Sensitivity Questionnaire-8 (VLSQ-8) and the monthly attack frequency score. In MwoA, significantly decreased CBF connectivity was detected between ORBmid.R and the left superior frontal gyrus, the right putamen, the right caudate, as well as the right angular gyrus. In addition, increased CBF connectivity was observed between the left calcarine cortex and ORBmid.R. CONCLUSIONS Our results indicate that migraine patients exhibit abnormalities in regional CBF and feature CBF connection defects at the resting state. The affected areas involve information perception, information integration, and emotional, pain and visual processing. Our findings might provide important clues for the pathophysiology of migraine.
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Affiliation(s)
- Di Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China
| | - Xiaobin Huang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China
| | - Cunnan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China
| | - Yuchen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China
| | - Zhengfei Miao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China
| | - Chunmei Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China
| | - Chenjie Xu
- Department of Pain Treatment, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China
| | - Xinying Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China.
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, Jiangsu, China.
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A novel computed tomography perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous aura stroke mimic. Neurol Sci 2020; 41:3321-3328. [PMID: 32458253 DOI: 10.1007/s10072-020-04476-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Migrainous aura (MA) represents the third most common stroke mimic (SM). Advanced neuroimaging is pivotal in the assessment of patients with focal neurological acute symptoms. We investigated brain perfusion alterations in MA-SM patients using a novel CT perfusion (CTP)-based quantitative approach in order to improve differential diagnosis between MA and acute stroke. METHODS We processed and analysed the clinical and neuroimaging CTP data, acquired within 4.5 h from symptom onset, of patients with acute focal neurological symptoms receiving a final diagnosis of MA. The differences between ROI, compatible with MA symptoms, and contralateral side were automatically estimated in terms of asymmetry index (AI%) by the newly developed tool for mean transit time (MTT), CBF, and cerebral blood volume (CBV) CTP parameters. The AI% ≥ 10% was considered significant. RESULTS Out of 923 admitted patients, 14 patients with MA were included. In 13 out of 14 cases, a significant pattern of hypoperfusion was observed by quantitative analysis in at least one of the CTP maps. In 7 patients, all three CTP maps were significantly altered. In particular, MTT-AI% increased in 11 (79%) cases, while CBF-AI% and CBV-AI% decreased in 12 (86%) and in 9 (64%) patients, respectively. All CBV values were above ischemic stroke core threshold and all MTT-AI were below ischemic penumbra threshold. CONCLUSIONS Our data suggest that a novel CTP-quantitative approach may detect during MA a moderate hypoperfusion pattern in the cerebral regions compatible with aura symptoms. The use of this novel tool could support differential diagnosis between MA and acute stroke.
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Abstract
Transient disturbances in neurologic function are disturbing features of migraine attacks. Aura types include binocular visual, hemi-sensory, language and unilateral motor symptoms. Because of the gradual spreading quality of visual and sensory symptoms, they were thought to arise from the cerebral cortex. Motor symptoms previously included as a type of migraine aura were reclassified as a component of hemiplegic migraine. ICHD-3 criteria of the International Headache Society, added brainstem aura and retinal aura as separate subtypes. The susceptibility to all types of aura is likely to be included by complex and perhaps epigenetic factors.
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Affiliation(s)
- Rod Foroozan
- Baylor College of Medicine, 6565 Fannin NC-205, Houston, TX 77030, USA.
| | - F Michael Cutrer
- Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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10
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Tee TY, Khoo CS, Raymond AA, Syazarina SO. Teaching NeuroImages: Neuroimaging in hemiplegic migraine. Neurology 2019; 93:e626-e627. [DOI: 10.1212/wnl.0000000000007905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ellingson BM, Hesterman C, Johnston M, Dudeck NR, Charles AC, Villablanca JP. Advanced Imaging in the Evaluation of Migraine Headaches. Neuroimaging Clin N Am 2019; 29:301-324. [PMID: 30926119 PMCID: PMC8765285 DOI: 10.1016/j.nic.2019.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The use of advanced imaging in routine diagnostic practice appears to provide only limited value in patients with migraine who have not experienced recent changes in headache characteristics or symptoms. However, advanced imaging may have potential for studying the biological manifestations and pathophysiology of migraine headaches. Migraine with aura appears to have characteristic spatiotemporal changes in structural anatomy, function, hemodynamics, metabolism, and biochemistry, whereas migraine without aura produces more subtle and complex changes. Large, controlled, multicenter imaging-based observational trials are needed to confirm the anecdotal evidence in the literature and test the scientific hypotheses thought to underscore migraine pathophysiology.
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Affiliation(s)
- Benjamin M Ellingson
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA; UCLA Brain Research Institute (BRI), David Geffen School of Medicine, University of California Los Angeles, 695 Charles E Young Dr S, Los Angeles, CA 90095, USA; UCLA Brain Tumor Imaging Laboratory (BTIL), Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; UCLA Brain Tumor Imaging Laboratory (BTIL), Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA.
| | - Chelsea Hesterman
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA
| | - Mollie Johnston
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA
| | - Nicholas R Dudeck
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA
| | - Andrew C Charles
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA
| | - Juan Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA
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Uetani H, Kitajima M, Sugahara T, Kikuchi H, Muto Y, Hirahara T, Tateishi M, Kuroki Y, Yamashita Y. Perfusion abnormality on three-dimensional arterial spin labeling with a 3T MR system in pediatric and adolescent patients with migraine. J Neurol Sci 2018; 395:41-46. [DOI: 10.1016/j.jns.2018.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 01/24/2023]
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13
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Santoro JD, Forkert ND, Yang QZ, Pavitt S, MacEachern SJ, Moseley ME, Yeom KW. Brain Diffusion Abnormalities in Children with Tension-Type and Migraine-Type Headaches. AJNR Am J Neuroradiol 2018; 39:935-941. [PMID: 29545251 DOI: 10.3174/ajnr.a5582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/01/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Tension-type and migraine-type headaches are the most common chronic paroxysmal disorders of childhood. The goal of this study was to compare regional cerebral volumes and diffusion in tension-type and migraine-type headaches against published controls. MATERIALS AND METHODS Patients evaluated for tension-type or migraine-type headache without aura from May 2014 to July 2016 in a single center were retrospectively reviewed. Thirty-two patients with tension-type headache and 23 with migraine-type headache at an average of 4 months after diagnosis were enrolled. All patients underwent DWI at 3T before the start of pharmacotherapy. Using atlas-based DWI analysis, we determined regional volumetric and diffusion properties in the cerebral cortex, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, brain stem, and cerebral white matter. Multivariate analysis of covariance was used to test for differences between controls and patients with tension-type and migraine-type headaches. RESULTS There were no significant differences in regional brain volumes between the groups. Patients with tension-type and migraine-type headaches showed significantly increased ADC in the hippocampus and brain stem compared with controls. Additionally, only patients with migraine-type headache showed significantly increased ADC in the thalamus and a trend toward increased ADC in the amygdala compared with controls. CONCLUSIONS This study identifies early cerebral diffusion changes in patients with tension-type and migraine-type headaches compared with controls. The hypothesized mechanisms of nociception in migraine-type and tension-type headaches may explain the findings as a precursor to structural changes seen in adult patients with chronic headache.
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Affiliation(s)
- J D Santoro
- From the Department of Neurology (J.D.S., Q.-Z.Y., S.P.), Division of Child Neurology
| | | | - Q-Z Yang
- From the Department of Neurology (J.D.S., Q.-Z.Y., S.P.), Division of Child Neurology
| | - S Pavitt
- From the Department of Neurology (J.D.S., Q.-Z.Y., S.P.), Division of Child Neurology
| | - S J MacEachern
- Pediatrics (S.J.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - M E Moseley
- Department of Radiology (M.E.M.), Stanford University School of Medicine, Stanford, California
| | - K W Yeom
- Department of Radiology (K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Stanford, California.
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Ridolfi M, Granato A, Polverino P, Furlanis G, Ukmar M, Zorzenon I, Manganotti P. Migrainous aura as stroke-mimic: The role of perfusion-computed tomography. Clin Neurol Neurosurg 2018; 166:131-135. [DOI: 10.1016/j.clineuro.2018.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/11/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
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Arterial Spin Labeling Cerebral Perfusion Magnetic Resonance Imaging in Migraine Aura: An Observational Study. J Stroke Cerebrovasc Dis 2018; 27:1262-1266. [PMID: 29331612 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/27/2017] [Accepted: 12/03/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Changes in cerebral perfusion during migraine with aura (MA) have been assessed mainly using dynamic susceptibility contrast (DSC) magnetic resonance perfusion imaging. A contrast agent-free method to assess these changes would be desirable. We assessed changes in cerebral perfusion during MA using arterial spin labeling (ASL) perfusion magnetic resonance imaging. METHODS We investigated 4 patients with a standardized protocol including ASL perfusion imaging during MA (n = 2) or early headache phase (n = 2) and asymptomatic follow-up. Semiquantitative evaluation was done using a region of interest (ROI) within hypoperfused or hyperperfused areas and corresponding ROIs in the contralateral hemisphere. Relative ratios of mean perfusion in the corresponding ROIs were calculated. DSC imaging was done at initial time points and compared visually with ASL findings. RESULTS In all patients, regional perfusion changes were detected in the acute phase. These abnormalities did not respect the boundaries of major cerebral vascular territories but overlapped onto adjoining regions. During MA, adjacent hypoperfused and hyperperfused areas were found, whereas during headache, regional hyperperfusion only was observed. Perfusion abnormalities normalized on follow-up. CONCLUSIONS ASL perfusion imaging is a contrast agent-free method suitable for assessment of reversible perfusion changes during or immediately after MA.
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Nyholt DR, Borsook D, Griffiths LR. Migrainomics — identifying brain and genetic markers of migraine. Nat Rev Neurol 2017; 13:725-741. [DOI: 10.1038/nrneurol.2017.151] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Kissoon NR, Cutrer FM. Aura and Other Neurologic Dysfunction in or with Migraine. Headache 2017; 57:1179-1194. [DOI: 10.1111/head.13101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Narayan R. Kissoon
- Division of Headache, Department of Neurology; Mayo Clinic; Rochester MN USA
| | - Fred Michael Cutrer
- Division of Headache, Department of Neurology; Mayo Clinic; Rochester MN USA
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Cha YH, Millett D, Kane M, Jen J, Baloh R. Adult-Onset Hemiplegic Migraine with Cortical Enhancement and Oedema. Cephalalgia 2016; 27:1166-70. [PMID: 17645764 DOI: 10.1111/j.1468-2982.2007.01369.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present genetically identical twin patients who experienced late-onset migraine with visual and somatosensory auras and later developed hemiplegic migraines associated with severe cortical oedema and enhancement. Both positron emission tomography and electroencephalography showed an increase in activity contralateral to the hemiplegic side. Brain biopsy during the attack showed reactive astrogliosis and microgliosis. Mutations in CACNA1A, ATP1A2, SLC1A3 and NOTCH3 were ruled out by sequencing. This report shows the clinical and genetic evaluation of a severe form of familial hemiplegic migraine as well as the evolution of the imaging changes.
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Affiliation(s)
- Y-H Cha
- Department of Neurology, University of California-Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
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19
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Kim S, Kang M, Choi S. A case report of sporadic hemiplegic migraine associated cerebral hypoperfusion: comparison of arterial spin labeling and dynamic susceptibility contrast perfusion MR imaging. Eur J Pediatr 2016; 175:295-8. [PMID: 26250760 DOI: 10.1007/s00431-015-2609-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/26/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED The pathogenesis of sporadic hemiplegic migraine remains unclear, and perfusion-weighted magnetic resonance imaging (PWI) has been used for characterization of hemodynamic changes in migraine aura. We report a case of sporadic hemiplegic migraine in which magnetic resonance perfusion imaging showed left cerebral hypoperfusion. Dynamic susceptibility contrast (DSC) perfusion maps showed hypoperfusion with posterior predominance in the left cerebral hemisphere. Findings with arterial spin labeling (ASL) perfusion correlated well with DSC perfusion findings. CONCLUSION With unique advantages compared with DSC PWI, ASL has significant potential in the evaluation of the patients with sporadic hemiplegic migraine. WHAT IS KNOWN Sporadic hemiplegic migraine is a rare variety of migraine defined by migraine attacks, which include the presence of motor weakness/hemiparesis during the aura phase and where no first- or second-degree relative (parent, sibling, or child) has identical attacks. WHAT IS NEW Reports on imaging abnormalities described in sporadic hemiplegic migraine are sparse. To our knowledge, this is the first report to describe arterial spin labeling (ASL) perfusion abnormalities in patients with sporadic hemiplegic migraine, as compared with dynamic susceptibility contrast perfusion-weighted magnetic resonance imaging (PWI).
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Affiliation(s)
- Sanghyeon Kim
- Department of Radiology, Dong-A University Medical Center, 1,3-ga, Dongdaeshin-dong, Seo-gu, Busan, 602-715, South Korea.
| | - Myongjin Kang
- Department of Radiology, Dong-A University Medical Center, 1,3-ga, Dongdaeshin-dong, Seo-gu, Busan, 602-715, South Korea.
| | - Sunseob Choi
- Department of Radiology, Dong-A University Medical Center, 1,3-ga, Dongdaeshin-dong, Seo-gu, Busan, 602-715, South Korea.
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Iizuka T, Tominaga N, Kaneko J, Sato M, Akutsu T, Hamada J, Sakai F, Nishiyama K. Biphasic neurovascular changes in prolonged migraine aura in familial hemiplegic migraine type 2. J Neurol Neurosurg Psychiatry 2015; 86:344-53. [PMID: 25411546 DOI: 10.1136/jnnp-2014-307731] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report biphasic changes in cerebral blood flow (CBF) in the acute phase of hemiplegic migraine with prolonged aura (HMPA), in which aura symptoms lasted longer than 24 h, in three patients with familial hemiplegic migraine (FHM) carrying a p.H916L mutation in ATP1A2 gene. METHODS We assessed neurovascular changes with time in the affected cerebral hemisphere corresponding to aura symptoms during the acute phase of HMPA. Arterial spin labelling MRI, SPECT for CBF measurement and EEG in three attacks, in one attack FDG-PET measurement for cerebral metabolism was performed. We evaluated CBF at different phases of aura symptoms in 11 attacks of HMPA. RESULTS In two attacks, we found biphasic CBF changes beginning with hypoperfusion followed by persistent hyperperfusion. FDG-PET revealed increased cerebral glucose metabolism in the regions corresponding to hyperperfusion on day 4 when aura symptoms still persisted. In four attacks, Z-score-based CBF mapping revealed multifocal hypoperfusion in the early phase. Hypoperfusion in our study was seen within 19 h of the onset of the symptoms in five of seven attacks, while hyperperfusion was seen 18 h or later in eight of nine attacks. EEG showed attenuated alpha activity without paroxysmal discharge. CONCLUSIONS This is the first report showing biphasic CBF changes during the prolonged aura of FHM2. This study suggested that the results of cross-sectional CBF studies should be interpreted carefully. Initial multifocal hypoperfusion is likely due to functional depression of multifocal origin in the affected hemisphere, but the mechanism of persistent hyperperfusion requires further investigation.
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Affiliation(s)
- Takahiro Iizuka
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naomi Tominaga
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Juntaro Kaneko
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mayumi Sato
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsugio Akutsu
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junichi Hamada
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Fumihiko Sakai
- Saitama International Headache Center, Saitama Neuropsychiatric Institute, Saitama, Japan
| | - Kazutoshi Nishiyama
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
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Changes in (99m)Tc-ECD SPECT and magnetic resonance angiography with sporadic hemiplegic migraine in a child. Clin Nucl Med 2014; 39:483-4. [PMID: 24662647 DOI: 10.1097/rlu.0000000000000401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sporadic hemiplegic migraine is rare in childhood. We followed a patient with Tc-ECD (Tc-ethyl cysteinate dimer) SPECT and magnetic resonance angiography (MRA). At the age of 8 years, he developed left hemiplegia. The MRA showed vasoconstriction of the posterior right middle cerebral artery. Hemiplegia disappeared in a few hours, and the MRA normalized. At the age of 10 years, right hemiplegia was observed, disappearing completely after a few days. During this second migraine attack, MRA demonstrated left middle cerebral artery vasoconstriction, and SPECT revealed decreased left hemisphere blood flow. Findings normalized as the patient recovered.
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Kim YJ, Kwon SU. Recurrent steroid-responsive cerebral vasogenic edema in status migrainosus and persistent aura. Cephalalgia 2014; 35:728-34. [DOI: 10.1177/0333102414553820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/14/2014] [Indexed: 11/16/2022]
Abstract
Background Status migrainosus (SM) and persistent aura (PA) without infarction are complications of migraine. Although several patients have been reported to have reversible brain lesions associated with complications of migraine, their nature and pathophysiology remain unclear. Case We report on a 38-year-old male who presented with nine episodes of SM and PA over eight years. Serial neuroimaging studies including brain magnetic resonance imaging (MRI), blood flow single photon emission tomography (SPECT),18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) and11 C-flumazenil PET (FMZ-PET) demonstrated cerebral vasogenic edema (CVE) with hypoperfusion and hypometabolism in the area, anatomically corresponding to the area with PA. SM and PA were effectively controlled by corticosteroid therapy. Follow-up MRI revealed complete reversibility of the CVE, which was supported by normal FMZ-PET and FDG-PET findings. Conclusion We have described a patient with transient brain lesions associated with complications of migraine who was diagnosed with fully reversible and steroid responsive CVE.
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Affiliation(s)
- Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
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Abstract
OBJECTIVES Migraine with aura is a common neurological disorder, and differentiation from transient ischemic attack or stroke based on clinical symptoms may be difficult. METHODS From an MRI report database we identified 33 patients with migraine with aura and compared these to 33 age-matched ischemic stroke patients regarding perfusion patterns on perfusion-weighted imaging (PWI)-derived maps: time to peak (TTP), mean transit time (MTT), and cerebral blood flow and volume (CBF, CBV). RESULTS In 18/33 (54.5%) patients with migraine with aura, TTP showed areas of hypoperfusion, most of these not limited to the territory of a specific artery but affecting two or more vascular territories. In patients with migraine with aura, TTP (1.09 ± 0.05 vs. 1.47 ± 0.40, p < 0.001) and MTT ratios (1.01 ± 0.10 vs. 1.19 ± 0.21, p = 0.003) were significantly lower compared to patients with ischemic stroke. In contrast to this, CBF and CBV ratios did not differ significantly between both groups. CONCLUSIONS Migraine aura is usually associated with a perfusion deficit not limited to a specific vascular territory, and only a moderate increase of TTP. Thus, hypoperfusion restricted to a single vascular territory in combination with a marked increase of TTP or MTT may be regarded as atypical for migraine aura and suggestive of acute ischemic stroke.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Holger Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Hans U Kerl
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany Department of Diagnostic and Interventional Neuroradiology, University Hospital of the RWTH Aachen, Germany
| | - Christoph Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany
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Eikermann-Haerter K, Negro A, Ayata C. Spreading depression and the clinical correlates of migraine. Rev Neurosci 2013; 24:353-63. [PMID: 23907418 DOI: 10.1515/revneuro-2013-0005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/27/2013] [Indexed: 12/14/2022]
Abstract
Migraine is the most common neurologic condition. One-third of migraineurs experience transient neurologic symptoms, the so-called aura. There is strong evidence that spreading depression (SD) is the electrophysiologic substrate of migraine aura. SD is an intense pan-depolarization wave that slowly propagates in gray matter by way of contiguity and transiently disrupts neuronal function. When induced subcortically, striatal SD causes hemiparesis, hippocampal SD can trigger seizures and impact cognition, and bilateral thalamic SD can diminish consciousness. Recent data show that transgenic mice expressing familial hemiplegic migraine (FHM) type 1 mutations in voltage-gated Ca2+ channels (Cav2.1) develop mutation-specific aura-like signs after a cortical SD similar to patients with the respective mutation. These signs are associated with facilitated subcortical SD propagation. As in FHM, mice with the R192Q mutation develop pure hemiplegia associated with cortical SDs propagating into caudoputamen. S218L mice display additional signs such as seizures and coma when SD propagates into hippocampus and thalamus. In hyperexcitable FHM brains, SD may propagate between cortex and subcortical structures via permissive gray matter bridges, or originate de novo in subcortical structures, to explain unusual and severe aura signs and symptoms. Reciprocal spread and reverberating waves can explain protracted attacks.
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25
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Schwedt TJ, Zhou J, Dodick DW. Sporadic hemiplegic migraine with permanent neurological deficits. Headache 2013; 54:163-6. [PMID: 24117121 DOI: 10.1111/head.12232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 11/27/2022]
Abstract
By definition, the neurologic impairments of hemiplegic migraine are reversible. However, a few cases of permanent neurologic deficits associated with hemiplegic migraine have been reported. Herein, we present the case of a patient with permanent impairments because of hemiplegic migraine despite normalization of associated brain magnetic resonance imaging abnormalities. Cases like these suggest the need to consider aggressive prophylactic therapy for patients with recurrent hemiplegic migraine attacks.
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Costa C, Tozzi A, Rainero I, Cupini LM, Calabresi P, Ayata C, Sarchielli P. Cortical spreading depression as a target for anti-migraine agents. J Headache Pain 2013; 14:62. [PMID: 23879550 PMCID: PMC3728002 DOI: 10.1186/1129-2377-14-62] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/08/2013] [Indexed: 12/18/2022] Open
Abstract
Spreading depression (SD) is a slowly propagating wave of neuronal and glial depolarization lasting a few minutes, that can develop within the cerebral cortex or other brain areas after electrical, mechanical or chemical depolarizing stimulations. Cortical SD (CSD) is considered the neurophysiological correlate of migraine aura. It is characterized by massive increases in both extracellular K⁺ and glutamate, as well as rises in intracellular Na⁺ and Ca²⁺. These ionic shifts produce slow direct current (DC) potential shifts that can be recorded extracellularly. Moreover, CSD is associated with changes in cortical parenchymal blood flow. CSD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs. Yet, no effects have been observed for the antiepileptic drugs carbamazepine and oxcarbazepine, consistent with their lack of efficacy on migraine. Some molecules of interest for migraine have been tested for their effect on CSD. Specifically, blocking CSD may play an enabling role for novel benzopyran derivative tonabersat in preventing migraine with aura. Additionally, calcitonin gene-related peptide (CGRP) antagonists have been recently reported to inhibit CSD, suggesting the contribution of CGRP receptor activation to the initiation and maintenance of CSD not only at the classic vascular sites, but also at a central neuronal level. Understanding what may be lying behind this contribution, would add further insights into the mechanisms of actions for "gepants", which may be pivotal for the effectiveness of these drugs as anti-migraine agents. CSD models are useful tools for testing current and novel prophylactic drugs, providing knowledge on mechanisms of action relevant for migraine.
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Affiliation(s)
- Cinzia Costa
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
- Fondazione Santa Lucia I.R.C.C.S., Via del Fosso di Fiorano, 00143, Rome, Italy
| | - Alessandro Tozzi
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
- Fondazione Santa Lucia I.R.C.C.S., Via del Fosso di Fiorano, 00143, Rome, Italy
| | - Innocenzo Rainero
- Neurology II, Department of Neuroscience, University of Torino, Ospedale Molinette, Via Cherasco 15, 10126, Turin, Italy
| | | | - Paolo Calabresi
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
- Fondazione Santa Lucia I.R.C.C.S., Via del Fosso di Fiorano, 00143, Rome, Italy
| | - Cenk Ayata
- Neurovascular Research Lab., Department of Radiology, Stroke Service and Neuroscience Intensive Unit Department of Neurology Massachusetts Hospital, Harvard Medical School, 02115, Boston, MA, USA
| | - Paola Sarchielli
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
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CT perfusion in acute stroke: Know the mimics, potential pitfalls, artifacts, and technical errors. Emerg Radiol 2013; 21:49-65. [DOI: 10.1007/s10140-013-1125-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/25/2013] [Indexed: 11/26/2022]
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The diagnostic role for susceptibility-weighted MRI during sporadic hemiplegic migraine. Cephalalgia 2013; 33:1258-63. [DOI: 10.1177/0333102413491027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Hemiplegic migraine is a rare form of migraine with aura that includes motor weakness. Diagnosis during the first episode can be difficult to make and costly, especially with the sporadic form. Cases Our study evaluates the ictal magnetic resonance imaging (MRI) features of four sequential pediatric patients during a first-time, sporadic hemiplegic migraine. Susceptibility-weighted imaging (SWI) revealed cerebral venous prominence and increased magnetic susceptibility affecting brain regions that corresponded with each patient’s neurologic deficits. Repeat MRI (performed in three patients) following migraine recovery demonstrated resolution of all susceptibility abnormalities. Conclusion When combined with conventional MRI sequences, SWI has diagnostic value in the acute setting of motor weakness and with clinical features consistent with hemiplegic migraine. The sequence may help to further characterize ictal cerebral blood flow changes during the hemiplegic migraine aura.
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Impact of 99mTc-HMPAO Brain Perfusion Scan in the Diagnosis of Hemiplegic Migraine. Clin Nucl Med 2013; 38:e103-5. [DOI: 10.1097/rlu.0b013e31826c0cf1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Cutrer FM, Smith JH. Human Studies in the Pathophysiology of Migraine: Genetics and Functional Neuroimaging. Headache 2012; 53:401-12. [DOI: 10.1111/head.12024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2012] [Indexed: 12/14/2022]
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McGehee BE, Pollock JM, Maldjian JA. Brain perfusion imaging: How does it work and what should I use? J Magn Reson Imaging 2012; 36:1257-72. [DOI: 10.1002/jmri.23645] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/17/2012] [Indexed: 11/09/2022] Open
Affiliation(s)
- Blake E. McGehee
- Department of Radiology, Wake Forest University School of Medicine, Winston‐Salem, North Carolina, USA
| | - Jeffrey M. Pollock
- Department of Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph A. Maldjian
- Department of Radiology, Wake Forest University School of Medicine, Winston‐Salem, North Carolina, USA
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Lakhan SE, Avramut M, Tepper SJ. Structural and functional neuroimaging in migraine: insights from 3 decades of research. Headache 2012; 53:46-66. [PMID: 23094683 DOI: 10.1111/j.1526-4610.2012.02274.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Modern imaging methods provide unprecedented insights into brain structure, perfusion, metabolism, and neurochemistry, both during and between migraine attacks. Neuroimaging investigations conducted in recent decades bring us closer to uncovering migraine as a multifaceted, primarily central nervous system disorder. Three main categories of structural and functional brain changes are described in this review, corresponding to the migrainous aura, ictal headache, and interictal states. These changes greatly advance our understanding of multiple pathophysiologic underpinnings of migraine, from central "migraine generating" loci, to cortical spreading depression, intimate mechanisms underlying activation of neuronal pain pathways in vulnerable patients, central sensitization, and chronification. Structural imaging begins to explain the complex connections between migraine and cerebral vascular events, white matter lesions, grey matter density alterations, iron deposition, and microstructural brain damage. Selected structural and functional alterations of brain structures, as identified with imaging methods, may represent the foundation of new diagnostic strategies and serve as markers of therapeutic efficacy.
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Affiliation(s)
- Shaheen E Lakhan
- From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.E. Lakhan and S.J. Tepper); Biosciences Department, Global Neuroscience Initiative Foundation, Beverly Hills, CA, USA (S.E. Lakhan and M. Avramut)
| | - Mihaela Avramut
- From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.E. Lakhan and S.J. Tepper); Biosciences Department, Global Neuroscience Initiative Foundation, Beverly Hills, CA, USA (S.E. Lakhan and M. Avramut)
| | - Stewart J Tepper
- From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.E. Lakhan and S.J. Tepper); Biosciences Department, Global Neuroscience Initiative Foundation, Beverly Hills, CA, USA (S.E. Lakhan and M. Avramut)
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Ohmura K, Suzuki Y, Saito Y, Wada T, Goto M, Seto S. Sporadic hemiplegic migraine presenting as acute encephalopathy. Brain Dev 2012; 34:691-5. [PMID: 22136990 DOI: 10.1016/j.braindev.2011.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/27/2011] [Accepted: 11/04/2011] [Indexed: 10/28/2022]
Abstract
A 10-year-old boy with psychomotor developmental delay and cerebellar vermis atrophy developed right hemiplegia with vomiting, unconsciousness, convulsions, and late-onset fever. Slow delta activity was noted over the left hemisphere on electroencephalography, and neuroimaging revealed swelling of the left temporo-occipital cerebral cortex with restricted diffusivity, successive transient cortical atrophy, and hyperperfusion over the left cerebral hemisphere. Interleukin-6 was elevated in the cerebrospinal fluid. The acute symptoms resolved completely within 3 weeks after onset, but hypoperfusion persisted in the left posterior cortex thereafter. Another episode with transient left hemiplegia appeared 7 months later, followed by recurrence of migraine attacks. Analysis of the CACNA1A gene revealed a mutation of c.1997 C>T (p.T666M). None of his family members had migraine. This case represents an unusual evolution of sporadic hemiplegic migraine with manifestations of acute encephalopathy, for which the role of migraine-related inflammatory process is assumed.
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Affiliation(s)
- Kayo Ohmura
- Department of Pediatrics, Kishiwada City Hospital, Kishiwada, Japan.
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Floery D, Vosko MR, Fellner FA, Fellner C, Ginthoer C, Gruber F, Ransmayr G, Doerfler A, Uder M, Bradley WG. Acute-onset migrainous aura mimicking acute stroke: MR perfusion imaging features. AJNR Am J Neuroradiol 2012; 33:1546-52. [PMID: 22517281 DOI: 10.3174/ajnr.a3020] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- D Floery
- Institute of Radiology, AKH Linz, Linz, Austria
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Asghar SJ, Milesi-Hallé A, Kaushik C, Glasier C, Sharp GB. Variable manifestations of familial hemiplegic migraine associated with reversible cerebral edema in children. Pediatr Neurol 2012; 47:201-4. [PMID: 22883286 DOI: 10.1016/j.pediatrneurol.2012.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/09/2012] [Indexed: 11/16/2022]
Abstract
Three children with familial hemiplegic migraine presented with right-sided weakness, speech difficulty, altered mental status, and gait abnormalities. These persistent aura signs were accompanied by left-sided slowing and cerebral dysfunction, documented by electroencephalograms. Cranial magnetic resonance imaging revealed cortical edema restricted to the left cerebral hemisphere. Follow-up electroencephalogram and imaging studies produced normal results 1-4 months afterward. However, cognitive changes persisted. Genetic testing demonstrated variable results: one child manifested a CACNA1A mutation compatible with familial hemiplegic migraine type 1, whereas another demonstrated an ATP1A2 sequence alteration. No known mutations were evident in the third child, with minor head trauma thought to precipitate the familial hemiplegic migraine. These findings demonstrate the variable clinical and genetic heterogeneity of childhood familial hemiplegic migraine.
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Affiliation(s)
- Sheila J Asghar
- Section of Pediatric Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
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Choi KH, Kim JS, Lee SY, Ryu SW, Kim SS, Lee SH, Kim S, Park HK. Familial hemiplegic migraine with prolonged coma and cerebellar atrophy: CACNA1A T666M mutation in a Korean family. J Korean Med Sci 2012; 27:1124-7. [PMID: 22969264 PMCID: PMC3429835 DOI: 10.3346/jkms.2012.27.9.1124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/25/2012] [Indexed: 11/20/2022] Open
Abstract
We report the first Korean patient with familial hemiplegic migraine type 1, with clinical and multimodal imaging findings. A 43-yr-old man was admitted for right hemianopia and aphasia, followed by coma. MRI showed only cerebellar atrophy. CT angiography showed mild vasodilation of intracranial blood vessels and increased vascularity in the left hemisphere and perfusion-weighted imaging showed elevated cerebral blood flow. Gene analysis of the patient and his mother led to the identification of a heterozygous point mutation (1997C→T, T666M) in exon 16 of the CACNA1A gene. Familial hemiplegic migraine should be considered in patients with episodic neurological dysfunction with cerebellar atrophy.
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Affiliation(s)
- Kyung-Ho Choi
- Department of Neurology, College of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jang Su Kim
- Department of Laboratory Medicine & Genetics, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Seo-Young Lee
- Department of Neurology, College of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Suk-won Ryu
- Department of Laboratory Medicine, College of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Sam Su Kim
- Department of Radiology, College of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung-hwan Lee
- Department of Neurology, College of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Sunghun Kim
- Department of Neurology, College of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Hee-Kwon Park
- Department of Neurology, College of Medicine, Inha University Hospital, Incheon, Korea
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Arias-Rivas S, Rodríguez-Yañez M, Cortés J, Pardo-Parrado M, Aguiar P, Leira R, Castillo J, Blanco M. Familial hemiplegic migraine with prolonged global aura: follow-up findings of subtraction ictal SPECT co-registered to MRI (SISCOM). Cephalalgia 2012; 32:1013-4. [PMID: 22933508 DOI: 10.1177/0333102412457093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
All authors contributed equally to this work. Susana Arias-Rivas wrote the main paper. Manuel Rodriguez-Yáñez investigated the supplementary data. Julia Cortés and Pablo Aguiar performed the nuclear image studies and analysed and described the neuroimaging results. María Pardo, Rogelio Leira and Jose Castillo jointly conceived the study, followed the patient and prepared the manuscript. Miguel Blanco discussed the results. All authors discussed the results and implications and commented on the manuscript at all stages.
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Affiliation(s)
- Susana Arias-Rivas
- Neurology Department, ANEVAS, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
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Eom TH, Bin JH, Kim YH, Chung SY, Lee IG. A pediatric sporadic hemiplegic migraine case with perfusion abnormality in perfusion MRI and Diamox 99mTc-HMPAO SPECT. Neurol Sci 2012; 34:595-7. [DOI: 10.1007/s10072-012-1094-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/11/2012] [Indexed: 11/24/2022]
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Arkink EB, Bleeker EJW, Schmitz N, Schoonman GG, Wu O, Ferrari MD, van Buchem MA, van Osch MJP, Kruit MC. Cerebral perfusion changes in migraineurs: a voxelwise comparison of interictal dynamic susceptibility contrast MRI measurements. Cephalalgia 2012; 32:279-88. [PMID: 22290556 DOI: 10.1177/0333102411435985] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The increased risk of cerebro- and cardiovascular disease in migraineurs may be the consequence of a systemic condition affecting whole body vasculature. At cerebrovascular level, this may be reflected by interictal global or regional cerebral perfusion abnormalities. Whether focal perfusion changes occur during interictal migraine has not been convincingly demonstrated. METHODS We measured brain perfusion with dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in 29 interictal female migraineurs (12 migraine with aura (MA), 17 migraine without aura (MO)), and 16 female controls. Perfusion maps were compared between these groups with a voxelwise (p < 0.001, uncorrected, minimum cluster size 20 voxels) and a region-of-interest approach. RESULTS In whole brain voxelwise analyses interictal hyperperfusion was observed in the left medial frontal gyrus in migraineurs and in the inferior and middle temporal gyrus in MO patients, in comparison with controls. Hypoperfusion was seen in the postcentral gyrus and in the inferior temporal gyrus in MA patients and in the inferior frontal gyrus in MO patients. Additional focal sites of hyperperfusion were noted in subgroups based on attack frequency and disease history. Region-of-interest analyses of the pons, hypothalamus, occipital lobe, and cerebellum did not show interictal perfusion differences between migraineurs and controls. CONCLUSIONS We conclude that interictal migraine is characterized by discrete areas of hyper- and hypoperfusion unspecific for migraine pathophysiology and not explaining the increased vulnerability of particular brain regions for cerebrovascular damage.
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Affiliation(s)
- Enrico B Arkink
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
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Neuronal death by repetitive cortical spreading depression in juvenile rat brain. Exp Neurol 2012; 233:438-46. [DOI: 10.1016/j.expneurol.2011.11.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/13/2011] [Accepted: 11/10/2011] [Indexed: 01/08/2023]
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Mourand I, Menjot de Champfleur N, Carra-Dallière C, Le Bars E, Roubertie A, Bonafé A, Thouvenot E. Perfusion-weighted MR imaging in persistent hemiplegic migraine. Neuroradiology 2011; 54:255-60. [DOI: 10.1007/s00234-011-0946-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/26/2011] [Indexed: 11/28/2022]
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42
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Hansen JM, Schytz HW, Larsen VA, Iversen HK, Ashina M. Hemiplegic Migraine Aura Begins With Cerebral Hypoperfusion: Imaging in the Acute Phase. Headache 2011; 51:1289-96. [DOI: 10.1111/j.1526-4610.2011.01963.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Russell MB, Ducros A. Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. Lancet Neurol 2011; 10:457-70. [DOI: 10.1016/s1474-4422(11)70048-5] [Citation(s) in RCA: 265] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Multimodal neuroimaging in a child with sporadic hemiplegic migraine: A contribution to understanding pathogenesis. Cephalalgia 2010; 31:751-6. [DOI: 10.1177/0333102410392068] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Hemiplegic migraine (HM) is a rare variety of migraine with aura, characterized by motor deficits during the aura, often beginning in childhood. The hemiplegic attacks can be severe and prolonged but the prognosis is usually good. Data on neuroimaging, including diffusion-weighted imaging (DWI) and spectroscopy, during prolonged attacks of HM are quite limited, particularly in children. Case: An eight-year-old female had a prolonged attack of sporadic HM characterized by right-sided hemiplegia, global aphasia, fever and impairment of consciousness. MRI nine hours after hemiplegia onset was negative, while the following MRI scans (days 4 and 11) documented a progressive increase in cortical swelling in the left hemisphere with mild hyperintensity on DWI and mild reduction of apparent diffusion coefficient values. Proton MRI spectroscopy (MRS) (day 15) showed a decrease in the N-acetylaspartate/creatine ratio in the left hemisphere. 99mTc-ECD single-photon emission tomography (SPET) (day 27) showed marked left hemispheric hypoperfusion. The patient recovered completely after 40 days and neuroimaging follow-up (MRI and SPET) after six months was normal. The patient carried a missense mutation of the ATP1A2 gene. Conclusion: Multimodal neuroimaging (MRI, DWI, MRS, SPET) in a prolonged HM attack supports evidence for a primary neuronal dysfunction.
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Cognitive functions, emotional behavior, and quality of life in familial hemiplegic migraine. Cogn Behav Neurol 2010; 23:106-11. [PMID: 20535059 DOI: 10.1097/wnn.0b013e3181c3a8a6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the cognitive functions, mood, and quality of life in a family with genetically proved familial hemiplegic migraine (FHM), carrying a missense mutation on chromosome 19 (T666M), corresponding to the most frequent FHM subtype. BACKGROUND FHM is an autosomal dominant subtype of migraine with an aura, characterized by hemiparesis during the aura. Whereas the genetic background of FHM has been studied intensely, less attention has been paid to cognitive functions and mood between attacks. METHOD Six patients performed neuropsychologic assessment between attacks. Depression, anxiety, and quality of life were evaluated by questionnaires. Cerebral magnetic resonance imaging was performed. RESULTS Neuropsychologic assessment revealed a distinct pattern of preserved and impaired functions. Whereas linguistic abilities and verbal memory were intact, all patients showed deficits in figural memory, executive functions, in some aspects of attention, and in dexterity. Intelligence of 1 patient was below average. All but 1 patient reported normal quality of life; there were no symptoms of depression or state anxiety. All patients showed cerebellar atrophy and cerebellar ataxia. CONCLUSION Cognitive abnormalities and cerebellar atrophy were found in all patients. FHM-related cognitive deficits may be associated to a disturbance of cerebrocerebellar circuits.
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47
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Kaniecki RG, Taylor FR, Stillman MJ. Abstracts and Citations. Headache 2010. [DOI: 10.1111/j.1526-4610.2010.01614.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Aphasic and visual aura with increased vasogenic leakage: An atypical migrainosus status. J Neurol Sci 2009; 285:227-9. [DOI: 10.1016/j.jns.2009.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 05/27/2009] [Accepted: 06/01/2009] [Indexed: 11/21/2022]
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Grimaldi D, Tonon C, Cevoli S, Pierangeli G, Malucelli E, Rizzo G, Soriani S, Montagna P, Barbiroli B, Lodi R, Cortelli P. Clinical and neuroimaging evidence of interictal cerebellar dysfunction in FHM2. Cephalalgia 2009; 30:552-9. [DOI: 10.1111/j.1468-2982.2009.01979.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We used multimodal magnetic resonance (MR) techniques [brain diffusion-weighted magnetic resonance imaging, diffusion-weighted imaging (DWI), proton MR spectroscopy (MRS), 1H-MRS; and skeletal muscle phosphorous MRS, 31P-MRS] to investigate interictal brain microstructural changes and tissue energy metabolism in four women with genetically determined familial hemiplegic migraine type 2 (FHM2), belonging to two unrelated families, compared with 10 healthy women. Brain DWI revealed a significant increase of the apparent diffusion coefficient median values in the vermis and cerebellar hemispheres of FHM2 patients, preceding in two subjects the onset of interictal cerebellar deficits. 31P-MRS revealed defective energy metabolism in skeletal muscle of FHM2 patients, while brain 1H-MRS showed a mild pathological increase in lactate in the lateral ventricles of one patient and a mild reduction of cortical N-acetyl-aspartate to creatine ratio in another one. Our MRS results showed that a multisystem energy metabolism defect in FHM2 is associated with microstructural cerebellar changes detected by DWI, even before the onset of cerebellar symptoms.
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Affiliation(s)
- D Grimaldi
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - C Tonon
- MR Spectroscopy Unit, Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Bologna, Italy
| | - S Cevoli
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - G Pierangeli
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - E Malucelli
- MR Spectroscopy Unit, Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - S Soriani
- Department of Clinical and Experimental Medicine–Paediatrics, University of Ferrara, Ferrara, Italy
| | - P Montagna
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - B Barbiroli
- MR Spectroscopy Unit, Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Bologna, Italy
| | - R Lodi
- MR Spectroscopy Unit, Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Bologna, Italy
| | - P Cortelli
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
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Wolf ME, Jäger T, Bäzner H, Hennerici M. Changes in functional vasomotor reactivity in migraine with aura. Cephalalgia 2009; 29:1156-64. [PMID: 19558541 DOI: 10.1111/j.1468-2982.2009.01843.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Migraine with aura (MA) is associated with cerebral hyper- and hypoperfusion during and after the attacks. Several attempts to estimate individual perfusion changes and asymmetries in patients with MA using transcranial Doppler (TCD) have not been consistent. In 70 patients with MA and 40 controls with migraine without aura (MoA) or without any history of migraine, interictally recorded TCD sequences were prospectively analysed. Formal curve analysis of the visually evoked flow response (VEFR) was performed semiautomatically. As a main parameter for functional vasomotor reactivity (fVMR), the visually evoked flow rate (VEFR%) was calculated. The VEFR% showed a significantly higher mean difference of 14.7 +/- 12% in MA patients vs. 5.8 +/- 4.4% (P < 0.001) in controls. The significant asymmetry of fVMR in MA patients is suggested to reflect interattack persisting vasomotor changes which are of pathophysiological interest and may be used as a monitoring tool under prophylactic medication.
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Affiliation(s)
- M E Wolf
- Universitätsklinikum Mannheim, Department of Neurology, Mannheim 68167, Germany.
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