Abstract Details

Title Computed Tomography Perfusion Abnormalities in Migraine Mimicking Acute Stroke Presentation

Topic Headache

Presentation(s) P06 - (-)

Poster/Presentation
Number 157

Objective

Background BACKGROUND: Migraine with aura occurs in 15-20% of migraine patients and may mimic stroke-like symptoms. Typical migraine auras are associated with visual disturbances and last for less than one hour. Prolonged or atypical auras present a challenge in distinguishing from TIA or stroke. CT perfusion is an important imaging modality that is routinely used in stroke centers in United States to decide therapeutic options especially when the history, time of onset and presentation of symptoms is unclear.

Design/Methods DESIGN/METHODS: We evaluated CT perfusion changes in a 21 year old male with history of common migraine who presented with atypical aura of aphasia lasting for more than one hour with transient right upper extremity weakness. CT perfusion parameters were studied during aura and acute phase of migraine and in postdrome phase after treatment with abortive medication.

Results RESULTS: CT perfusion done during acute phase showed delayed time to peak, delayed mean transit time, decreased cerebral blood flow, and increased cerebral blood volume suggestive of reversible ischemia in the left middle cerebral artery (MCA) distribution. CT perfusion done during postdrome after treating subsequent similar migraine attack 2 days later showed reversal of the above CT perfusion parameters with no evidence of ischemia or infarction. CT non-contrast, and CT angiogram performed with both CT perfusion studies were normal without evidence of any stenosis. MR imaging did not show any abnormal restriction of diffusion.

Conclusions CONCLUSIONS: Atypical aura of migraine can mimic clinical presentation as well as radiological findings of TIA / stroke. Cautious approach is advocated when using CT perfusion to decide therapeutic options for TIA / stroke.

Authors/Disclosures
Vikram Jadhav, MD (Minnesota Stroke Network) PRESENTER	No disclosure on file
Roumen D. Balabanov, MD (Northwestern University)	Dr. Balabanov has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Balabanov has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Balabanov has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Balabanov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Balabanov has received research support from NextCure. The institution of Dr. Balabanov has received research support from Biogen. The institution of Dr. Balabanov has received research support from NINDS.

��ɫ��

��ɫ��