Migrainous aura as stroke-mimic: the role of perfusion-computed tomography

The acute-onset of migrainous aura (MA) can be misguidedly identified as acute stroke (AS) in the Emergency Department (ED), and it can be defined as “stroke mimic” (SM).

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Key take away

Migrainuos aura (MA) can be classified in a heterogeneous group of pathologies called stroke mimics (SM). A complete diagnostic workup, including neuroimaging, is important for an accurate differential diagnosis between MA and acute stroke (AS). Only a few studies have been performed with perfusion computed tomography (PCT) during the migrainous aura. Therefore in this study, the author investigates the patterns of PCT in patients with migraine with aura.

Background

The acute-onset of migrainous aura (MA) can be misguidedly identified as acute stroke (AS) in the Emergency Department (ED), and it can be defined as “stroke mimic” (SM). The diagnosis of infracts can be improved using the perfusion computer tomography (PCT). This study aimed to investigate the PCT role in the ED to improve detection of migrainous aura. A comparison between the data and well-defined perfusion patterns of the acute ischemic stroke patients was done.

Method

A standardised Stroke Protocol was followed for the study. The protocol incorporated in centralising in ED every patient with acute-onset of neurological symptoms showed compatibility with cerebrovascular disease, and in operating hematological tests, brain non-contrast computed tomography (NCCT), neurological and general examination, CT angiography (CTA) of the intracranial arteries and supra-aortic and cerebral PCT. Subjects with the determination of probable or definite acute stroke were admitted in the Stroke Unit (SU). All subjects from the Stroke Protocol and those discharged from SU or ED with a diagnosis of migraine with aura were went through a six-months retrospective analysis.

Result

A total of 172 individuals were incorporated in the Stroke Protocol, and six subjects were registered. PCT, NCCT, and CTA were executed after 60–90 min from the beginning of symptoms and disclosed normal perfusion. Only one patient went through the intravenous thrombolysis.

Conclusion

The patients with acute-onset of neurological symptoms, who have quick progressive improvement of symptoms, normal neuroimaging, in specific PCT, and preceding episodes of migraine with aura, considered to be suffering from MA. Among these cases, even though thrombolysis is invulnerable, clinicians may delay a prompt aggressive treatment.