Brain apparent water diffusion coefficient magnetic resonance image during a prolonged visual aura.
BACKGROUND
Reversible changes in brain magnetic resonance imaging (MRI) weighted in diffusion-weighted images (DWI) and apparent water diffusion coefficient (ADC) maps have been reported in acute stroke, epilepsy, eclampsia, and hypoglycemia, but they are contradictory regarding to migraine aura.


OBJECTIVE
A 41-year-old woman with known basilar migraine for 5 years consulted about a persistent visual aura (visual snow phenomenon) plus bilateral paresthesias in the extremities for 4 days. The headache was treated with success with 10 mg of wafer rizatriptan and 600 mg of ibuprophen.


METHODS
The neurologic and ophthalmologic examination were normal. An urgent brain MRI detected no lesions in T1, T2, fluid-attenuated inversion recovery, and DWI, but an abnormal signal appeared in the left occipital lobe in ADC and (r)ADC maps. The brain MRI angiography, carotid ultrasound study, transesophageal echocardiography, 24-hour cardiac Holter monitoring, and thrombophilia study were normal.


RESULTS
A new brain MRI 8 days after did not show any previous lesion in the same sequences.


CONCLUSIONS
We present a patient with migraine and transitory abnormal signals in the ADC map of an occipital region during persistent visual aura. The clinical-radiological relationship is congruent. Some similar cases have showed these MRI signals during the aura, suggesting cytotoxic edema, without ischemic lesions in the MRI controls. Theses ADC images probably appear in complex auras.
Belvís
Robert
R
Department of Neurology, USP Dexeus University Institute, Barcelona, Spain.
Ramos
Rafael
R
Villa
Carolina
C
Segura
Cristóbal
C
Pagonabarraga
Javier
J
Ormazabal
Inmaculada
I
Kulisevsky
Jaime
J
D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007091:Image Processing, Computer-Assisted; D020325:Migraine with Aura / Q000188:drug therapy / Q000503:physiopathology*; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D014363:Tryptamines / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; C093622:rizatriptan; D007052:Ibuprofen