CT Perfusion and CT Angiography in children and juvenile patients during an attack of migraine with aura

Aims: The pathophysiology of migraine is not yet fully understood and stroke has to be included in differential diagnosis. The neurogenic theory is confirmed by neuroimaging studies with functional MRI during auras indicating that the decreases in cortical bloodflow are not sufficient to cause ischemia and the subsequent vasodilatation is observed well after the beginning of headache. Neuroimaging descriptions during migraine attacks are limited to MRI, but this technology is not widely available on a 24h basis. Recent developments in CT technology allows high speed volumetric data acquisition and generation of perfusion maps.

The purpose of the paper is to present findings of CT-Perfusion and CT-Angiography (CTA) in patients with migraine.

Methods: 10 Patients (8–17years) with hemiparesis were investigated by CT (including perfusion CTA – AquilionOne TMS) in order to rule out/confirm stroke.

Results: Two of ten children suffered from cerebral infarction and in the eight remaining migraine with aura was diagnosed – four of them having signs of regional hypoperfusion as indicated by diminished cerebral blood flow and but normal blood volume. On CTA peripheral arterial rarefication could be detected within the affected areas. Only in one child suffering from a severe migraine attack the focal hypoperfusion was read as potentially indicating early stroke, which was excluded by follow-up MRI. CT dose was within the range of 2–3 head CT.

Conclusion: Perfusion CT and CTA enable imaging of vascular disturbances in migraine. The findings of hypoperfusion can be misinterpretad as cerebral infarction, but normal cerebral blood volumes on CT-Perfusion excludes stroke. Therefore in emergency situations, were stroke has to be excluded and MRI is not available in time, CT could be an alternative.

CT - MR - migraine - cerebral perfusion