Presentation
Presents with headaches, aphasia, and right hemiparesis. MR to rule out ischemia.
Patient Data
there is venous dilatation on SWI MIP images contralateral to the hemiparesis (due to vasodilatation)
global hypoperfusion of the left cerebral hemisphere on ASL MR perfusion sequences
all of the left distal arterial branches arising from the anterior, middle, and posterior cerebral arteries are smaller compared to the right side (arterial vasoconstriction)
there is no white matter abnormality nor restricted diffusion
Case Discussion
Typical MR features of left hemiplegic migraine. The diagnosis is in line with the clinical presentation (aphasia and right hemiparesis).
A rare kind of migraine known as hemiplegic migraine with aura characterized by recurrent bouts of variable degrees of focal weakness associated with migraine.
Radiological features includes:
in the early aura (vasoconstriction) phase, arterial vasoconstriction and hypoperfusion involving the hemisphere contralateral to the side of hemiparesis, with asymmetric prominence of deoxygenated blood in cerebral veins on SWI,1
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in the later headache (vasodilation) phase, MRI may demonstrate hyperperfusion and possible reversible mild diffuse cerebral cortical edema and diffusion restriction 1
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