[Prolonged migrainous aura and acute ischemic insult. Differential diagnosis by diffusion- and perfusion-weighted cMRI].
BACKGROUND
According to the "time is brain" concept, differential diagnosis of acute stroke and prolonged migrainous aura is of vital importance in this era of systemic thrombolysis for acute cerebral ischemia. We demonstrate the value of cerebral magnetic resonance imaging (cMRI) in acute situations by presenting two patients.


METHODS
Two patients were sent to our hospital for lysis treatment after the sudden appearance of global aphasia and slight right-sided hemiparesis. Further exploration was impossible due to the aphasia, and therefore we performed diffusion- and perfusion-weighted cMRI.


RESULTS
We excluded acute cerebral infarction by the aid of diffusion-weighted cMRI, however left-sided cerebral hypoperfusion was seen in both patients. After resolution of neurologic symptoms, unilateral headache occurred and both patients reported pre-existing migraine with aura.


CONCLUSIONS
Hypoperfusion of the malfunctioning brain region contralateral to the affected side of the body has been described on cMRI in only a few patients with prolonged migrainous aura. We conclude from our two cases that--provided rapid availability--cMRI can add important information for differential diagnosis, in particular when lysis therapy is a treatment option.
Kraus
J
J
Neurologische Universitätsklinik, Paracelsus Medizinische Privatuniversität, Christian-Doppler-Klinik, Salzburger Landeskliniken, Ignaz-Harrer-Strasse 79, Salzburg, Austria. joerg.kraus@salk.at
Golaszewski
S
S
Luthringshausen
G
G
Hold
R
R
Pilz
G
G
Tasch
G
G
Ladurner
G
G
D000328:Adult; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D008297:Male; D020325:Migraine with Aura / Q000150:complications* / Q000175:diagnosis*; D020521:Stroke / Q000150:complications* / Q000175:diagnosis*