title: Perfusion-weighted MR imaging in persistent hemiplegic migraine.
abstract: BACKGROUND
  Hemiplegic migraine is a rare type of migraine that has an aura characterized by the presence of motor weakness, which may occasionally last up to several days, and then resolve without sequela. Pathogenesis of migraine remains unclear and, recently, perfusion-weighted imaging (PWI) has provided a non-invasive method to study hemodynamic changes during acute attacks.
  
  
  METHODS
  Two female patients were admitted in our hospital suffering from prolonged hemiparesis. In both cases, they underwent MRI examination using a 1.5 T magnet including axial diffusion-weighted and perfusion sequences. From each perfusion MRI acquisition two regions of interest were delineated on each hemisphere and, the index of flow, cerebral blood volume, mean transit time, and time to peak were recorded and asymmetry indices from each perfusion parameter were calculated.
  
  
  RESULTS
  Perfusion alterations were detected during the attacks. In one case, we observed, after 3 h of left hemiparesia, hypoperfusion of the right hemisphere. In the other case, who presented a familial hemiplegic migraine attack, on the third day of a persistent aura consisting of right hemiplegia and aphasia, PWI revealed hyperperfusion of the left hemisphere. Asymmetry indices for temporal parameters (mean transit time and time to peak) were the most sensitive. These findings resolved spontaneously after the attacks without any permanent sequel or signs of cerebral ischemia on follow-up MRI.
  
  
  CONCLUSIONS
  PWI should be indicated for patients with migraine attacks accompanied by auras to assess the sequential changes in cerebral perfusion and to better understand its pathogenesis.
authors.affiliation: Service de Neuroradiologie, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France. i-mourand@chu-montpellier.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mourand
authors.forename: Nicolas
authors.initials: N
authors.lastname: Menjot de Champfleur
authors.forename: Clarisse
authors.initials: C
authors.lastname: Carra-Dallière
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Le Bars
authors.forename: Agathe
authors.initials: A
authors.lastname: Roubertie
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafé
authors.forename: Eric
authors.initials: E
authors.lastname: Thouvenot
mesh_terms: D000328:Adult; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D020325:Migraine with Aura / Q000175:diagnosis*