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Updated: May 23, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Acute-onset migrainous aura mimicking acute stroke: MR perfusion imaging features
D Floery1, M R Vosko, F A Fellner
1Institute of Radiology, AKH Linz, Linz, Austria.
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.
Insights
Acute migrainous aura can mimic stroke on MR perfusion imaging. Recognizing these atypical patterns, such as widespread hypoperfusion, is crucial for accurate diagnosis and avoiding misdiagnosis of acute brain infarction.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Acute migrainous aura can present with neurological symptoms mimicking acute brain infarction.
- Distinguishing between migrainous aura and stroke is critical for appropriate patient management.
Purpose of the Study:
- To identify and characterize patterns of MR perfusion abnormalities in patients with acute migrainous aura.
- To aid in the differential diagnosis of suspected acute brain infarction.
Main Methods:
- Retrospective analysis of 1850 MR imaging studies for suspected acute brain infarction.
- Identification of patients with acute migrainous aura.
- Standard stroke MR imaging protocol including perfusion-weighted imaging (PWI).
- Visual and quantitative review of perfusion maps by radiologists.
Main Results:
- 20 cases (1.08%) of acute migrainous aura were identified.
- 70% of patients showed hypoperfusion, primarily delayed transit time (rMTT, TTP) and decreased cerebral blood flow (rCBF).
- Perfusion abnormalities were atypical for stroke, affecting multiple vascular territories and often with posterior predominance.
Conclusions:
- Acute migrainous aura is a rare but significant consideration in the differential diagnosis of suspected stroke.
- MR perfusion imaging can reveal atypical patterns in migrainous aura that differ from typical stroke findings.
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