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Perfusion and pH MRI in familial hemiplegic migraine with prolonged aura
Jakob Udby Blicher1, Anna Tietze2, Manus J Donahue3
1Center of Functionally Integrative Neuroscience, Aarhus University, Denmark Department of Neurology, Aarhus University Hospital, Denmark jbli@cfin.au.dk.
Introduction:
To investigate tissue flow disturbance and hypoxia during migraine aura, we studied a case of familial hemiplegic migraine (FHM) using novel magnetic resonance imaging (MRI) techniques.
Case Results:
A 44-year-old male was admitted with suspected stroke because of confusion and aphasia. Initial gadolinium-based perfusion MRI showed a decrease in cerebral blood flow and an increase in capillary flow disturbances within the left hemisphere. Later during the prolonged aura phase, chemical exchange saturation transfer MRI indicated a drop in pH in the affected area. The patient was diagnosed with an R908Q mutation in the ATP1A2 gene causing FHM type 2.
Discussion:
During prolonged aura in FHM, MRI shows reduced CBF, capillary flow disturbances and a possible pH drop that could indicate tissue hypoxia.
Insights
Novel magnetic resonance imaging (MRI) revealed reduced cerebral blood flow and capillary disturbances during prolonged migraine aura. This suggests potential tissue hypoxia in familial hemiplegic migraine (FHM) cases.
Area of Science:
- Neurology
- Neuroimaging
- Medical Diagnostics
Background:
- Investigating the pathophysiology of migraine aura, specifically tissue flow disturbance and hypoxia.
- Utilizing advanced magnetic resonance imaging (MRI) techniques for detailed analysis.
Observation:
- A case of familial hemiplegic migraine (FHM) with prolonged aura was studied.
- Initial perfusion MRI demonstrated reduced cerebral blood flow (CBF) and capillary flow disturbances.
- Chemical exchange saturation transfer MRI indicated a pH drop in the affected hemisphere.
Findings:
- Prolonged aura in FHM is associated with decreased CBF and capillary flow disturbances.
- A potential drop in tissue pH suggests a state of hypoxia during the aura phase.
- The patient presented with symptoms of confusion and aphasia, diagnosed as FHM type 2 due to an ATP1A2 gene mutation.
Implications:
- MRI findings provide insights into the mechanisms of migraine aura.
- Tissue hypoxia may play a role in the neurological deficits experienced during prolonged aura.
- These findings could inform future diagnostic and therapeutic strategies for FHM.
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