Grégoire Boulouis1, Eimad Shotar1, Volodia Dangouloff-Ros1, David Grévent1, Raphaël Calmon1, Francis Brunelle1, Olivier Naggara1,2, Manoelle Kossorotoff3, Nathalie Boddaert1. 1. Pediatric Radiology Department, Hôpital Necker - Enfants Malades, INSERM UMR1163 and U1000, Institut Imagine, Université Paris Descartes - Sorbonne Paris Cité, Paris, France. 2. Department of Neuroradiology, Centre Hospitalier Sainte-Anne, INSERM U894, Université Paris Descartes, Paris, France. 3. Pediatric Neurology Department and French Center for Pediatric Stroke, APHP, Hôpital Necker -Enfants Malades, Paris, France.
Abstract
AIM: Atypical migraine with aura can be challenging to diagnose. Arterial-spin-labelling (ASL) is able to non-invasively quantify brain perfusion. Our aim was to report cerebral blood flow (CBF) alterations using ASL, at the acute phase of atypical migraine with aura in children. METHOD: Paediatric patients were retrospectively included if (1) referred for acute neurological deficit(s), (2) underwent brain magnetic resonance imaging (MRI) at presentation with ASL sequence, and (3) had subsequent diagnosis of migraine with aura. Neurological symptom-free controls were matched for age. Twenty-eight regions of interest (ROIs) were drawn on CBF maps for each participant/control. RESULTS: Ten patients were included (median age 13y, range 8-16y). Eight of 10 had multiple aura symptoms during the episode. For every patient, CBF was decreased in a brain region consistent with symptoms when MRI was performed less than 14 hours after onset (n=7 patients) and increased if the MRI was performed 17 hours or more after (n=4 MRIs). INTERPRETATION: MRI-ASL appears to be a promising tool for the diagnostic workup and differentials exclusion in paediatric migraine with aura. Constant and time-consistent non-territorial CBF modifications were found in our sample providing additional insight to migraine with aura pathophysiology. The authors encourage implementing this sequence at the acute phase of unexplained paediatric neurological deficits, with or without accompanying headache.
AIM: Atypical migraine with aura can be challenging to diagnose. Arterial-spin-labelling (ASL) is able to non-invasively quantify brain perfusion. Our aim was to report cerebral blood flow (CBF) alterations using ASL, at the acute phase of atypical migraine with aura in children. METHOD: Paediatric patients were retrospectively included if (1) referred for acute neurological deficit(s), (2) underwent brain magnetic resonance imaging (MRI) at presentation with ASL sequence, and (3) had subsequent diagnosis of migraine with aura. Neurological symptom-free controls were matched for age. Twenty-eight regions of interest (ROIs) were drawn on CBF maps for each participant/control. RESULTS: Ten patients were included (median age 13y, range 8-16y). Eight of 10 had multiple aura symptoms during the episode. For every patient, CBF was decreased in a brain region consistent with symptoms when MRI was performed less than 14 hours after onset (n=7 patients) and increased if the MRI was performed 17 hours or more after (n=4 MRIs). INTERPRETATION: MRI-ASL appears to be a promising tool for the diagnostic workup and differentials exclusion in paediatric migraine with aura. Constant and time-consistent non-territorial CBF modifications were found in our sample providing additional insight to migraine with aura pathophysiology. The authors encourage implementing this sequence at the acute phase of unexplained paediatric neurological deficits, with or without accompanying headache.
Authors: Benjamin M Ellingson; Chelsea Hesterman; Mollie Johnston; Nicholas R Dudeck; Andrew C Charles; Juan Pablo Villablanca Journal: Neuroimaging Clin N Am Date: 2019-02-19 Impact factor: 2.264