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Brain apparent water diffusion coefficient magnetic resonance image during a prolonged visual aura.

Robert Belvís¹, Rafael Ramos, Carolina Villa

¹Department of Neurology, USP Dexeus University Institute, Barcelona, Spain.

|April 23, 2010

Summary

Transient MRI abnormalities in the occipital lobe, specifically in apparent water diffusion coefficient (ADC) maps, were observed during a persistent migraine aura. These findings suggest cytotoxic edema without infarction, highlighting a potential imaging marker for complex migraine auras.

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Area of Science:

Neuroimaging
Neurology
Radiology

Background:

Reversible MRI signal changes are documented in various neurological conditions like stroke and epilepsy.
Previous reports on MRI findings in migraine aura are contradictory.
The role of diffusion-weighted imaging (DWI) and apparent water diffusion coefficient (ADC) maps in migraine aura requires further clarification.

Observation:

A patient with a history of basilar migraine presented with a persistent 4-day visual aura and bilateral extremity paresthesias.
Neurological and ophthalmological examinations were unremarkable.
Initial brain MRI revealed no abnormalities on standard sequences (T1, T2, FLAIR, DWI).

Findings:

An urgent brain MRI demonstrated abnormal signals in the left occipital lobe on ADC and (r)ADC maps.
Follow-up MRI 8 days later showed complete resolution of the abnormal signals.
Associated investigations including MRI angiography, carotid ultrasound, echocardiography, Holter monitoring, and thrombophilia studies were normal.

Implications:

This case suggests that transient ADC abnormalities in the occipital lobe can occur during complex migraine auras.
The observed signals may indicate cytotoxic edema, distinct from ischemic lesions.
These findings support a potential clinical-radiological correlation in complex migraine aura and may represent a specific imaging signature.