Time Course of Cerebral Perfusion Changes in Children with Migraine with Aura Mimicking Stroke

Area of Science:

• Neurology
• Pediatric Neurology
• Radiology

Background:

• Hemiplegic migraine is a significant cause of acute neurological events in children.
• Differentiating hemiplegic migraine from stroke is critical for appropriate management.
• Advanced Magnetic Resonance (MR) imaging sequences offer potential diagnostic value.

Purpose of the Study:

• To evaluate the utility of simultaneous multimodal MR imaging sequences in pediatric patients with acute hemiplegic migraine or migraine with aura.
• To explore the diagnostic performance of arterial spin-labeling (ASL), Susceptibility-Weighted Imaging (SWI), MR Angiography (MRA), and Diffusion-Weighted Imaging (DWI) in this population.
• To investigate perfusion dynamics during acute migraine episodes.

Main Methods:

• Retrospective analysis of 12 pediatric patients with acute hemiplegic migraine or migraine with aura.
• MR imaging performed within 12 hours of symptom onset.
• Quantitative and qualitative analysis of ASL, SWI, and MRA sequences; DWI was assessed qualitatively.

Main Results:

• All patients exhibited normal DWI findings.
• Abnormal arterial spin-labeling findings were consistently observed.
• A faster transition from hypoperfusion to hyperperfusion was noted in three patients compared to previous literature.
• Multimodal MRI successfully distinguished migraine with aura from stroke.

Conclusions:

• Multimodal MR imaging, particularly ASL, is valuable in differentiating pediatric hemiplegic migraine from stroke.
• Simultaneous use of ASL, SWI, and MRA enhances the understanding of perfusion alterations in migraine with aura.
• These findings support the integration of these advanced MRI techniques in the diagnostic workup of pediatric migraine.