Headache Medicine, v.10, n.2, p.63-64, 2019
63
IMAGENS
Migraine with aura: MRI with perfusion aspects in the ictal
and interictal phases
Enxaqueca com aura: aspectos da ressonância magnética
com perfusão nas fases ictal e interictal
Paulo Sergio Faro Santos
1
Bruno Augusto Telles
2
1
Instituto de Neurologia de Curitiba,
Departamento de Neurologia -
Curitiba - PR - Brasil
2
Instituto de Neurologia de Curitiba,
CETAC - Diagnóstico por Imagens -
Curitiba - PR - Brasil
*Correspondence
Paulo Sergio Faro Santos
E-mail: dr.paulo.faro@gmail.com
Received: October 4, 2019.
Accepted: October 4, 2019.
We describe the case of a 16-year-old adolescent with diagnostic
previous of migraine without and with aura (only sensory), who presented
with aphasia of speech, associated with severe retroorbital pain and frontal
headache on the left, associated with nausea, photo and phonophobia.
He was admitted to the emergency room with suspected stroke and was
submitted to magnetic resonance perfusion imaging of the brain (Figure 1).
After ruling out suspected cerebral ischemia, treatment with symptomatic
medications was performed, progressing to improvement of symptoms
after about 2 hours.
Figure 1. A-D demonstrated fast protocol to exclude recent ischemia or bleeding,
with patency of large intracranial vessels and without signicant changes in structural
images (Diffusion, Gradient-Echo and FLAIR). E-H with the reconstructions of the
perfusion study and highlighting the important increase in time to the plateau (TTP
- gure G) and mean transit time (MTT - gure F), with no changes of the other
parameters. I-M with the perfusion control study and characterizing the regression of
the previously evidenced changes.
Approximately 1 month later, a new perfusion MRI was performed for
comparison, which revealed complete disappearance of the alterations
of the rst exam. In this interval, the patient presented only episodes of
migraine without aura.
Migraine with aura (MwA) accounts for about 30% of all cases of
migraine and predominates in females
(1)
. Its diagnosis was recently updated
by the third edition of the International Classication of Headache Disorders
(2)
. Visual aura accounts for 99% of auras, followed by sensory (54%) and
speech / language (32%)
(1)
.
10(2).indb 63 21/10/2019 18:25:28
Migraine with aura
Santos PSF, et al.
64
Headache Medicine, v.10, n.2, p.63-64, 2019
Usually at the rst manifestation or at the change in
the aura pattern, neuroimaging is necessary, considering
secondary headache, because one of the main
differential diagnoses is the stroke. The gradual onset of
neurological decits, the association with headache that
is typically migrainous, and the absence of ischemia on
neuroimaging exams are suggestive of MwA
(2,3)
. Perfusion
MRI in the ictal phase reveals decreased cerebral blood
ow, with no abnormalities in the DWI sequence, that is,
at sub-ischemic levels. Vascular alteration that is reversed
in the interictal period
(3)
.
REFERENCES
1. DeLange JM, Cutrer FM. Our evolving understanding
of migraine with aura. Curr Pain Headache Rep.
2014;18(10):453.
2. Headache Classication Committee of the International
Headache Society. The International Classication of
Headache Disorders. Cephalalgia. 2018; 38 (3rd edition):
1-211.
3. Russo A, Silvestro M, Tessitore A, Tedeschi G. Recent insights
in migraine with aura: a narrative review of advanced
neuroimaging. Headache. 2019 Apr;59(4):637-649.
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