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Hemiplegic Migraine Aura Begins With Cerebral Hypoperfusion: Imaging in the Acute Phase

Authors

  • Jakob M. Hansen MD, PhD,

    Corresponding author
      J.M. Hansen, Danish Headache Center, Department of Neurology N01, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Nordre Ringvej 57, DK-2600 Glostrup, Copenhagen, Denmark, email: jmh@dadlnet.dk.
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  • Henrik W. Schytz MD, PhD,

    1. From Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (J.M. Hansen, H.W. Schytz, and M. Ashina); Glostrup Stroke Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (H.K. Iversen); Radiology and Functional Imaging Unit, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (V.A. Larsen).
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  • Vibeke A. Larsen MD, PhD,

    1. From Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (J.M. Hansen, H.W. Schytz, and M. Ashina); Glostrup Stroke Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (H.K. Iversen); Radiology and Functional Imaging Unit, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (V.A. Larsen).
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  • Helle K. Iversen MD, DrMSc,

    1. From Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (J.M. Hansen, H.W. Schytz, and M. Ashina); Glostrup Stroke Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (H.K. Iversen); Radiology and Functional Imaging Unit, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (V.A. Larsen).
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  • Messoud Ashina MD, PhD, DrMSc

    1. From Danish Headache Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (J.M. Hansen, H.W. Schytz, and M. Ashina); Glostrup Stroke Center, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (H.K. Iversen); Radiology and Functional Imaging Unit, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (V.A. Larsen).
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  • Patient confidentiality: All patients gave informed consent.

  • Conflict of Interest: None

J.M. Hansen, Danish Headache Center, Department of Neurology N01, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Nordre Ringvej 57, DK-2600 Glostrup, Copenhagen, Denmark, email: jmh@dadlnet.dk.

Abstract

(Headache 2011;51:1289-1296)

Imaging studies of spontaneous migraine aura have proved challenging because of the episodic and unpredictable nature of migraine attacks. Two patients with signs of acute ischemic stroke were evaluated for thrombolysis and turned out to suffer from familial hemiplegic migraine. It was possible to record the early phase of the hemiplegic aura with computed tomography with perfusion sequences and magnetic resonance imaging. We found cerebral hypoperfusion in the relevant cortical areas within the first hour after onset of aura symptoms. This report supports the concept that migraine aura across the migraine spectrum is caused by similar mechanisms. In a setting with efficient cooperation between headache and stroke neurologists, thrombolysis centers provide the set-up and opportunity to record aura symptoms at an early phase. Furthermore, in the time of ready access to acute systemic thrombolysis treatment, these cases underscore the importance of an accurate headache history, especially in younger patients.

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