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Imaging Neurovascular Uncoupling in Acute Migraine with Aura with Susceptibility Weighted Imaging

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Abstract

Purpose

Migraine with aura (MwA) in the emergency setting is common and sometimes difficult to distinguish from mimicking conditions. Susceptibility weighted imaging (SWI), a magnet resonance (MR) technique is sensitive to deoxygenated hemoglobin in cerebral veins and depicts these according to their level of oxygenation. Our study aimed at evaluating the frequency of regions of prominent focal veins (PFV) on SWI in the acute phase.

Methods

Between 2011 and 2018 we evaluated symptoms and MR imaging of adult patients with acute MwA attacks (< 5 days after onset of symptoms). Abnormal imaging was visually scored in 12 ROIs on both hemispheres distributed on 3 slices. The score ranged from 0 to 3.

Results

In all, 638 patients (436 female) mean age 37.39 years (18–89 ± 14.13) were included. Susceptibility weighted imaging was abnormal in 18.8% of patients. The inferior and posterior medial temporal lobe and the occipital lobe were most often affected. Susceptibility weighted imaging was more likely abnormal when MR was performed within 24 hours with an average around 5 hours after symptom onset. The side of aura symptoms and hemispheric imaging alteration in patients with abnormal SWI was highly significant (p < 0.001).

Conclusion

In the acute episode of MwA, SWI imaging can show a combination of increased deoxygenation. The results may indicate linking PFV to MwA.

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Acknowledgements

This study was partially supported by Bayer (Swiss) AG, Zurich, Switzerland. All resources were made available by the Inselspital, University of Bern, Switzerland.

Author information

Authors and Affiliations

  1. Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Frauke Kellner-Weldon, Marina Jossen, Philipe S. Breiding, Lorenz Grunder, Raphaela Muri, Manuela Pastore-Wapp, Roland Wiest & Marwan El-Koussy

  2. Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Christoph Schankin, Adrian Scutelnic & Urs Fischer

  3. Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland

    Frauke Kellner-Weldon

Authors
  1. Frauke Kellner-Weldon
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  2. Marina Jossen
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  3. Philipe S. Breiding
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  4. Lorenz Grunder
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  7. Urs Fischer
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  8. Raphaela Muri
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  9. Manuela Pastore-Wapp
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  10. Roland Wiest
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  11. Marwan El-Koussy
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Corresponding author

Correspondence to Frauke Kellner-Weldon.

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Conflict of interest

F. Kellner-Weldon, M. Jossen, P.S. Breiding, L. Grunder, C. Schankin, A. Scutelnic, U. Fischer, R. Muri, M. Pastore-Wapp and M. El-Koussy declare that they have no competing interests. R. Wiest: unrelated: grants/grants pending: Swiss National Foundation, Swiss Heart Foundation.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional local ethics committee, Bern, Switzerland Project ID: PB_2018-00128 and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Data from this study were orally presented at the ASNR in Boston 2019 by Frauke Kellner-Weldon.

The current manuscript has not been published in whole or in part, and is not under consideration by another journal.

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Kellner-Weldon, F., Jossen, M., Breiding, P.S. et al. Imaging Neurovascular Uncoupling in Acute Migraine with Aura with Susceptibility Weighted Imaging. Clin Neuroradiol 31, 581–588 (2021). https://doi.org/10.1007/s00062-020-00962-7

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  • DOI: https://doi.org/10.1007/s00062-020-00962-7

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