Teaching NeuroImages: Magnetic resonance perfusion and diffusion findings in hemiplegic migraine

Abstract

A 6-year-old boy presented with acute onset of left-sided weakness and homonymous hemianopia in the setting of 3 days of severe, unilateral, pulsating headache. MRI 3 hours after symptom onset showed hypoperfusion of the entire right hemisphere, with foci of diffusion restriction predominantly involving the right parietal lobe with apparent diffusion coefficient correlate (figure). He gradually improved and was discharged with no neurologic deficits. He was discovered to have a strong family history of hemiplegic migraine.