Pearls & Oy-sters: Dynamics of altered cerebral perfusion and neurovascular coupling in migraine aura

Abstract

A 37-year-old woman presented 90 minutes after acute onset of mild motor aphasia with word-finding difficulties and hypesthesia of the right arm. MRI was immediately performed as she presented within the 3-hour time window for IV thrombolysis. Diffusion-weighted images (DWI) were normal, but perfusion MRI (dynamic susceptibility contrast) sequences showed marked hypoperfusion in the left hemisphere affecting both middle cerebral artery and posterior cerebral artery (PCA) territories. These findings were considered compatible with migraine aura. The patient subsequently developed a mild left-sided headache. Clinical symptoms gradually improved to full recovery after 6 hours without specific treatment. Follow-up MRI perfusion scans were obtained 24 hours and 2 months after the episode. Functional transcranial Doppler (fTCD) from the P2-segments of the PCA during visual stimulation was performed at the same time points as MRI (figure). The first follow-up MRI showed only mild residual hypoperfusion in the left hemisphere, and in the asymptomatic state 2 months later, no perfusion abnormality was detected. Correspondingly, initial severe changes of neurovascular coupling on fTCD …