title: Perfusion and pH MRI in familial hemiplegic migraine with prolonged aura.
abstract: BACKGROUND
  To investigate tissue flow disturbance and hypoxia during migraine aura, we studied a case of familial hemiplegic migraine (FHM) using novel magnetic resonance imaging (MRI) techniques.
  
  
  METHODS
  A 44-year-old male was admitted with suspected stroke because of confusion and aphasia. Initial gadolinium-based perfusion MRI showed a decrease in cerebral blood flow and an increase in capillary flow disturbances within the left hemisphere. Later during the prolonged aura phase, chemical exchange saturation transfer MRI indicated a drop in pH in the affected area. The patient was diagnosed with an R908Q mutation in the ATP1A2 gene causing FHM type 2.
  
  
  CONCLUSIONS
  During prolonged aura in FHM, MRI shows reduced CBF, capillary flow disturbances and a possible pH drop that could indicate tissue hypoxia.
authors.affiliation: Center of Functionally Integrative Neuroscience, Aarhus University, Denmark Department of Neurology, Aarhus University Hospital, Denmark jbli@cfin.au.dk.
authors.forename: Jakob Udby
authors.initials: JU
authors.lastname: Blicher
authors.affiliation: Center of Functionally Integrative Neuroscience, Aarhus University, Denmark.
authors.forename: Anna
authors.initials: A
authors.lastname: Tietze
authors.affiliation: Department of Radiology, Vanderbilt University School of Medicine, USA Department of Physics and Astronomy, Vanderbilt University School of Medicine, USA.
authors.forename: Manus J
authors.initials: MJ
authors.lastname: Donahue
authors.affiliation: Department of Radiology, Vanderbilt University School of Medicine, USA Department of Physics and Astronomy, Vanderbilt University School of Medicine, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Smith
authors.affiliation: Center of Functionally Integrative Neuroscience, Aarhus University, Denmark.
authors.forename: Leif
authors.initials: L
authors.lastname: Østergaard
mesh_terms: D000328:Adult; D002560:Cerebrovascular Circulation / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020325:Migraine with Aura / Q000235:genetics / Q000503:physiopathology*; D009154:Mutation; D010375:Pedigree; D000254:Sodium-Potassium-Exchanging ATPase / Q000235:genetics
chemical_list: C498531:ATP1A2 protein, human; D000254:Sodium-Potassium-Exchanging ATPase
keywords: MRI; Migraine; cerebral blood flow; chemical exchange saturation transfer; familial hemiplegic migraine; genetics; pH