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A Novel Computed Tomography Perfusion-based Quantitative Tool For Evaluation Of Perfusional Abnormalities In Migrainous Aura Stroke Mimic

A. Granato, Laura D’Acunto, M. Ajčević, G. Furlanis, M. Ukmar, Roberta Antea Pozzi Mucelli, P. Manganotti
Published 2020 · Medicine

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Background Migrainous aura (MA) represents the third most common stroke mimic (SM). Advanced neuroimaging is pivotal in the assessment of patients with focal neurological acute symptoms. We investigated brain perfusion alterations in MA-SM patients using a novel CT perfusion (CTP)-based quantitative approach in order to improve differential diagnosis between MA and acute stroke. Methods We processed and analysed the clinical and neuroimaging CTP data, acquired within 4.5 h from symptom onset, of patients with acute focal neurological symptoms receiving a final diagnosis of MA. The differences between ROI, compatible with MA symptoms, and contralateral side were automatically estimated in terms of asymmetry index (AI%) by the newly developed tool for mean transit time (MTT), CBF, and cerebral blood volume (CBV) CTP parameters. The AI% ≥ 10% was considered significant. Results Out of 923 admitted patients, 14 patients with MA were included. In 13 out of 14 cases, a significant pattern of hypoperfusion was observed by quantitative analysis in at least one of the CTP maps. In 7 patients, all three CTP maps were significantly altered. In particular, MTT-AI% increased in 11 (79%) cases, while CBF-AI% and CBV-AI% decreased in 12 (86%) and in 9 (64%) patients, respectively. All CBV values were above ischemic stroke core threshold and all MTT-AI were below ischemic penumbra threshold. Conclusions Our data suggest that a novel CTP-quantitative approach may detect during MA a moderate hypoperfusion pattern in the cerebral regions compatible with aura symptoms. The use of this novel tool could support differential diagnosis between MA and acute stroke.
This paper references
10.1016/j.jstrokecerebrovasdis.2017.09.067
Novel Algorithm to Help Identify Stroke Mimics.
Nadeem I Khan (2018)
10.3174/ajnr.A2026
Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls
Y. Lui (2010)
10.1177/0333102418767999
When migraine mimics stroke: A systematic review
A. Terrin (2018)
10.1097/01.wco.0000227040.16071.a9
Migraine with aura: new understanding from clinical epidemiologic studies
M. Kirchmann (2006)
10.1161/STROKEAHA.116.013842
FABS: An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department
N. Goyal (2016)
10.1161/01.STR.0000209238.61459.39
Perfusion-CT Assessment of Infarct Core and Penumbra: Receiver Operating Characteristic Curve Analysis in 130 Patients Suspected of Acute Hemispheric Stroke
M. Wintermark (2006)
10.1016/j.jstrokecerebrovasdis.2013.04.018
Predictors of acute stroke mimics in 8187 patients referred to a stroke service.
J. Merino (2013)
10.1016/j.clineuro.2012.08.012
Reversible CT perfusion abnormalities in patient with migraine variant: A two phase process
L. Shah (2013)
10.1111/1754-9485.12422
CT perfusion in acute stroke calls: A pictorial review and differential diagnoses
A. Chiu (2016)
10.1007/s10072-019-03838-y
Does the migraine attack start in the cortex and is the cortex critical in the migraine process?
P. Barbanti (2019)
The stroke-migraine depolarization continuum. Neuron
JP Dreier (2015)
10.1111/j.1468-2982.2009.02007.x
Migraine aura presenting as dysphasia with global cognitive dysfunction and abnormalities on perfusion CT
D. J. Nieuwkamp (2010)
10.1016/j.seizure.2019.07.005
CT perfusion and EEG patterns in patients with acute isolated aphasia in seizure-related stroke mimics
P. Manganotti (2019)
10.5348/IJCRI-2014-03-478-CR-9
Prolonged aphasia and perfusion computed tomography abnormalities in migraine with aura
A. Angermaier (2014)
10.1007/s00330-017-5174-4
Advanced CT for diagnosis of seizure-related stroke mimics
Friederike Austein (2017)
10.1016/j.jstrokecerebrovasdis.2018.04.003
Ischemic Volume and Neurological Deficit: Correlation of Computed Tomography Perfusion with the National Institutes of Health Stroke Scale Score in Acute Ischemic Stroke.
G. Furlanis (2018)
10.1097/RMR.0000000000000129
CT-based Techniques for Brain Perfusion.
P. Krishnan (2017)
10.1016/j.clineuro.2018.01.032
Migrainous aura as stroke-mimic: The role of perfusion-computed tomography
M. Ridolfi (2018)
10.1016/j.neuron.2015.04.004
The Stroke-Migraine Depolarization Continuum
J. Dreier (2015)
10.1016/j.jstrokecerebrovasdis.2013.07.012
Stroke mimics under the drip-and-ship paradigm.
S. Mehta (2014)
10.1371/journal.pone.0176622
Comparative accuracy of CT perfusion in diagnosing acute ischemic stroke: A systematic review of 27 trials
Jiantong Shen (2017)
10.1159/000474934
Acute Intravenous Calcium Antagonist for Suspected Hemiplegic Migraine – A Case Story
C. L. Rath (2017)
10.1016/j.jstrokecerebrovasdis.2017.12.002
Arterial Spin Labeling Cerebral Perfusion Magnetic Resonance Imaging in Migraine Aura: An Observational Study.
M. Wolf (2018)
10.1152/JN.1944.7.6.359
SPREADING DEPRESSION OF ACTIVITY IN THE CEREBRAL CORTEX
A. A. P. Leão (1944)
10.1007/s10072-017-3051-1
Is CT perfusion helpful in the treatment allocation of patients with acute ischemic stroke? An expert-opinion analysis
L. Strada (2017)
10.1007/s10072-017-2873-1
Stroke-like attack: first episode of sporadic hemiplegic migraine
E. Ferrante (2017)
10.1111/j.1468-2982.2006.01131.x
Imaging Abnormalities in Sporadic Hemiplegic Migraine on Conventional MRI, Diffusion and Perfusion MRI and MRS
A. Jacob (2006)
10.1007/s10140-013-1125-9
CT perfusion in acute stroke: Know the mimics, potential pitfalls, artifacts, and technical errors
R. Mangla (2013)
10.1007/s10140-012-1051-2
Susceptibility-weighted imaging and computed tomography perfusion abnormalities in diagnosis of classic migraine
C. Miller (2012)
10.1177/0333102413485658
The International Classification of Headache Disorders, 3rd edition (beta version)
H. Moon (2013)
10.1111/j.1468-2982.2007.01318.x
Aphasic Migraineous Aura With Left Parietal Hypoperfusion: A Case Report
J. Linn (2007)
10.3174/ajnr.A5508
Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance
F. Kellner-Weldon (2018)
10.1007/s10072-018-3343-0
Microvascular vasospasm of cerebral cortex in prolonged aura migraine
S. Viola (2018)
10.1007/s00431-015-2609-2
A case report of sporadic hemiplegic migraine associated cerebral hypoperfusion: comparison of arterial spin labeling and dynamic susceptibility contrast perfusion MR imaging
S. Kim (2015)
10.1007/s00234-011-0946-z
Perfusion-weighted MR imaging in persistent hemiplegic migraine
I. Mourand (2011)
10.1002/ana.25096
Heterogenous migraine aura symptoms correlate with visual cortex functional magnetic resonance imaging responses
N. Arngrim (2017)
10.1111/j.1526-4610.2008.01121.x
The International Classification of Headache Disorders
J. Olesen (2008)
10.1111/j.1468-2982.2003.00706.x
Familial Hemiplegic Migraine: Follow-up Findings of Diffusion-Weighted Magnetic Resonance Imaging (MRI), Perfusion-MRI and [99mTc] HMPAO-SPECT in a Patient with Prolonged Hemiplegic Aura
S. Oberndorfer (2004)
10.1002/ANA.410280610
Timing and topography of cerebral blood flow, aura, and headache during migraine attacks
J. Olesen (1990)
10.1111/ijs.12491
International Survey of Acute Stroke Imaging Used to Make Revascularization Treatment Decisions
M. Wintermark (2015)
10.1007/s10072-018-3468-1
Blood-brain barrier permeability assessed by perfusion computed tomography predicts hemorrhagic transformation in acute reperfusion therapy
T. Kim (2018)
10.3174/ajnr.A3020
Acute-Onset Migrainous Aura Mimicking Acute Stroke: MR Perfusion Imaging Features
D. Floery (2012)
10.1111/j.1526-4610.2011.01963.x
Hemiplegic Migraine Aura Begins With Cerebral Hypoperfusion: Imaging in the Acute Phase
J. B. Hansen (2011)
10.1136/jnnp-2014-307731
Biphasic neurovascular changes in prolonged migraine aura in familial hemiplegic migraine type 2
T. Iizuka (2014)
10.1007/s10072-018-3486-z
Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy
P. Caruso (2018)
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10.1136/jnnp-2012-303752
CT perfusion improves diagnostic accuracy and confidence in acute ischaemic stroke
B. Campbell (2013)



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