title: Acute-onset migrainous aura mimicking acute stroke: MR perfusion imaging features.
abstract: OBJECTIVE
  In a very limited number of cases, acute migrainous aura may mimic acute brain infarction. The aim of this study was to recognize patterns of MR perfusion abnormalities in this presentation.
  
  
  METHODS
  One thousand eight hundred fifty MR imaging studies performed for the suspicion of acute brain infarction were analyzed retrospectively to detect patients with acute migrainous aura not from stroke. All patients were examined clinically by 2 neurologists and underwent a standard stroke MR imaging protocol, including PWI. Two radiologists reviewed the perfusion maps visually and quantitatively for the presence, distribution, and grade of perfusion abnormalities.
  
  
  RESULTS
  Among 1850 MR imaging studies, 20 (1.08%) patients were found to have acute migrainous aura. Hypoperfusion was found in 14/20 patients (70%) with delayed rMTT and TTP, decreased rCBF, and minimal decrease in rCBV. In contrast to the typical pattern in stroke, perfusion abnormalities were not limited to a single vascular territory but extended to >1. Bilateral hypoperfusion was seen in 3/14 cases. In 11/14 cases, hypoperfusion with a posterior predominance was found. TTP and rMTT were the best maps to depict perfusion changes at visual assessment, but also rCBF maps demonstrated significant hypoperfusion in quantitative analysis. In all patients, clinical and imaging follow-up findings were negative for stroke.
  
  
  CONCLUSIONS
  Acute migrainous aura is rare but important in the differential diagnosis among patients with the suspicion of acute brain infarction. Atypical stroke perfusion abnormalities can be seen in these patients.
authors.affiliation: Institute of Radiology, AKH Linz, Linz, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Floery
authors.forename: M R
authors.initials: MR
authors.lastname: Vosko
authors.forename: F A
authors.initials: FA
authors.lastname: Fellner
authors.forename: C
authors.initials: C
authors.lastname: Fellner
authors.forename: C
authors.initials: C
authors.lastname: Ginthoer
authors.forename: F
authors.initials: F
authors.lastname: Gruber
authors.forename: G
authors.initials: G
authors.lastname: Ransmayr
authors.forename: A
authors.initials: A
authors.lastname: Doerfler
authors.forename: M
authors.initials: M
authors.lastname: Uder
authors.forename: W G
authors.initials: WG
authors.lastname: Bradley
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002536:Cerebral Arteries / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis; D002560:Cerebrovascular Circulation; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000175:diagnosis*; D020521:Stroke / Q000175:diagnosis*; D055815:Young Adult