Brain Apparent Water Diffusion Coefficient Magnetic Resonance Image During a Prolonged Visual Aura

Authors

  • Robert Belvís MD, PhD,

    1. From Department of Neurology, USP Dexeus University Institute, Barcelona, Spain (R. Belvís, C. Villa, J. Pagonabarraga, and J. Kulisevsky); Department of Radiology, USP Dexeus University Institute, Barcelona, Spain (R. Ramos, C. Segura, and I. Ormazabal).
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  • Rafael Ramos MD,

    1. From Department of Neurology, USP Dexeus University Institute, Barcelona, Spain (R. Belvís, C. Villa, J. Pagonabarraga, and J. Kulisevsky); Department of Radiology, USP Dexeus University Institute, Barcelona, Spain (R. Ramos, C. Segura, and I. Ormazabal).
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  • Carolina Villa MD,

    1. From Department of Neurology, USP Dexeus University Institute, Barcelona, Spain (R. Belvís, C. Villa, J. Pagonabarraga, and J. Kulisevsky); Department of Radiology, USP Dexeus University Institute, Barcelona, Spain (R. Ramos, C. Segura, and I. Ormazabal).
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  • Cristóbal Segura MD,

    1. From Department of Neurology, USP Dexeus University Institute, Barcelona, Spain (R. Belvís, C. Villa, J. Pagonabarraga, and J. Kulisevsky); Department of Radiology, USP Dexeus University Institute, Barcelona, Spain (R. Ramos, C. Segura, and I. Ormazabal).
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  • Javier Pagonabarraga MD, PhD,

    1. From Department of Neurology, USP Dexeus University Institute, Barcelona, Spain (R. Belvís, C. Villa, J. Pagonabarraga, and J. Kulisevsky); Department of Radiology, USP Dexeus University Institute, Barcelona, Spain (R. Ramos, C. Segura, and I. Ormazabal).
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  • Inmaculada Ormazabal MD,

    1. From Department of Neurology, USP Dexeus University Institute, Barcelona, Spain (R. Belvís, C. Villa, J. Pagonabarraga, and J. Kulisevsky); Department of Radiology, USP Dexeus University Institute, Barcelona, Spain (R. Ramos, C. Segura, and I. Ormazabal).
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  • Jaime Kulisevsky MD, PhD

    1. From Department of Neurology, USP Dexeus University Institute, Barcelona, Spain (R. Belvís, C. Villa, J. Pagonabarraga, and J. Kulisevsky); Department of Radiology, USP Dexeus University Institute, Barcelona, Spain (R. Ramos, C. Segura, and I. Ormazabal).
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  • Conflict of Interest: None

R. Belvís, C/Sabino Arana n°5-19, cp 08028 Barcelona, Spain.

Abstract

(Headache 2010;50:1045-1049)

Background.— Reversible changes in brain magnetic resonance imaging (MRI) weighted in diffusion-weighted images (DWI) and apparent water diffusion coefficient (ADC) maps have been reported in acute stroke, epilepsy, eclampsia, and hypoglycemia, but they are contradictory regarding to migraine aura.

Objective.— A 41-year-old woman with known basilar migraine for 5 years consulted about a persistent visual aura (visual snow phenomenon) plus bilateral paresthesias in the extremities for 4 days. The headache was treated with success with 10 mg of wafer rizatriptan and 600 mg of ibuprophen.

Methods.— The neurologic and ophthalmologic examination were normal. An urgent brain MRI detected no lesions in T1, T2, fluid-attenuated inversion recovery, and DWI, but an abnormal signal appeared in the left occipital lobe in ADC and (r)ADC maps. The brain MRI angiography, carotid ultrasound study, transesophageal echocardiography, 24-hour cardiac Holter monitoring, and thrombophilia study were normal.

Results.— A new brain MRI 8 days after did not show any previous lesion in the same sequences.

Conclusions.— We present a patient with migraine and transitory abnormal signals in the ADC map of an occipital region during persistent visual aura. The clinical-radiological relationship is congruent. Some similar cases have showed these MRI signals during the aura, suggesting cytotoxic edema, without ischemic lesions in the MRI controls. Theses ADC images probably appear in complex auras.

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