Diffusion MRI during migraine with aura attack associated with diagnostic microbubbles injection in subjects with

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Lavinia Dinia1, Luca Roccatagliata, Laura Bonzano

  • 1Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Italy.

Headache
|December 7, 2007
PubMed

Insights

Migraine with aura attacks occurred during contrast transcranial Doppler (cTCD) tests in patients with large patent foramen ovale (PFO). These attacks may be triggered by non-ischemic mechanisms, not necessarily stroke.

Area of Science:

  • Neurology
  • Cardiology
  • Diagnostic Imaging

Background:

  • The association between migraine with aura and patent foramen ovale (PFO) remains uncertain.
  • Contrast transcranial Doppler (cTCD) with microbubble injection is a diagnostic tool used to assess PFO.

Observation:

  • Two cases presented with migraine with aura attacks immediately following diagnostic microbubble injection via cTCD.
  • Both subjects had large, confirmed PFOs.
  • In one case, advanced MRI including diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping during the aura showed no signs of acute ischemic changes.

Findings:

  • Diagnostic procedures involving microbubble contrast agents in patients with PFO can precipitate migraine with aura attacks.
  • The observed attacks during cTCD in patients with PFO might not be indicative of ischemic events.
  • Absence of signal abnormalities on DWI and ADC in one patient suggests a non-ischemic etiology for the aura.

Implications:

  • Clinicians should be aware of the potential for triggering migraine with aura during cTCD with microbubble studies in PFO patients.
  • Further research is needed to elucidate the non-ischemic mechanisms underlying these attacks.
  • This finding may refine diagnostic protocols and patient counseling for individuals with PFO undergoing transcranial Doppler evaluations.

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