title: Perfusion patterns in migraine with aura.
abstract: OBJECTIVE
  Migraine with aura is a common neurological disorder, and differentiation from transient ischemic attack or stroke based on clinical symptoms may be difficult.
  
  
  METHODS
  From an MRI report database we identified 33 patients with migraine with aura and compared these to 33 age-matched ischemic stroke patients regarding perfusion patterns on perfusion-weighted imaging (PWI)-derived maps: time to peak (TTP), mean transit time (MTT), and cerebral blood flow and volume (CBF, CBV).
  
  
  RESULTS
  In 18/33 (54.5%) patients with migraine with aura, TTP showed areas of hypoperfusion, most of these not limited to the territory of a specific artery but affecting two or more vascular territories. In patients with migraine with aura, TTP (1.09 ± 0.05 vs. 1.47 ± 0.40, p < 0.001) and MTT ratios (1.01 ± 0.10 vs. 1.19 ± 0.21, p = 0.003) were significantly lower compared to patients with ischemic stroke. In contrast to this, CBF and CBV ratios did not differ significantly between both groups.
  
  
  CONCLUSIONS
  Migraine aura is usually associated with a perfusion deficit not limited to a specific vascular territory, and only a moderate increase of TTP. Thus, hypoperfusion restricted to a single vascular territory in combination with a marked increase of TTP or MTT may be regarded as atypical for migraine aura and suggestive of acute ischemic stroke.
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany Alex.Foerster@umm.de.
authors.forename: Alex
authors.initials: A
authors.lastname: Förster
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Wenz
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany.
authors.forename: Hans U
authors.initials: HU
authors.lastname: Kerl
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany Department of Diagnostic and Interventional Neuroradiology, University Hospital of the RWTH Aachen, Germany.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Brockmann
authors.affiliation: Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Groden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000175:diagnosis*; D020521:Stroke / Q000175:diagnosis*; D055815:Young Adult
keywords: DWI; MRA; Migraine; PWI; aura; perfusion