Abstract
Background
Migrainous aura (MA) represents the third most common stroke mimic (SM). Advanced neuroimaging is pivotal in the assessment of patients with focal neurological acute symptoms. We investigated brain perfusion alterations in MA-SM patients using a novel CT perfusion (CTP)-based quantitative approach in order to improve differential diagnosis between MA and acute stroke.
Methods
We processed and analysed the clinical and neuroimaging CTP data, acquired within 4.5 h from symptom onset, of patients with acute focal neurological symptoms receiving a final diagnosis of MA. The differences between ROI, compatible with MA symptoms, and contralateral side were automatically estimated in terms of asymmetry index (AI%) by the newly developed tool for mean transit time (MTT), CBF, and cerebral blood volume (CBV) CTP parameters. The AI% ≥ 10% was considered significant.
Results
Out of 923 admitted patients, 14 patients with MA were included. In 13 out of 14 cases, a significant pattern of hypoperfusion was observed by quantitative analysis in at least one of the CTP maps. In 7 patients, all three CTP maps were significantly altered. In particular, MTT-AI% increased in 11 (79%) cases, while CBF-AI% and CBV-AI% decreased in 12 (86%) and in 9 (64%) patients, respectively. All CBV values were above ischemic stroke core threshold and all MTT-AI were below ischemic penumbra threshold.
Conclusions
Our data suggest that a novel CTP-quantitative approach may detect during MA a moderate hypoperfusion pattern in the cerebral regions compatible with aura symptoms. The use of this novel tool could support differential diagnosis between MA and acute stroke.
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Abbreviations
- CBF:
-
Cerebral blood flow
- CBV:
-
Cerebral blood volume
- CT:
-
Computed tomography
- CTP:
-
Computed tomography perfusion
- CTA:
-
Computed tomography angiography
- DWI:
-
Diffusion-weighted imaging
- ED:
-
Emergency Department
- MA:
-
Migrainous aura
- MTT:
-
Mean transit time
- MRI:
-
Magnetic resonance imaging
- NECT:
-
Non-enhanced CT
- NIHSS:
-
National Institutes of Health Stroke Scale
- ROI:
-
Region of interest
- SM:
-
Stroke mimic
- SU:
-
Stroke unit
- TTP:
-
Time to peak
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The authors thank Matteo di Franza for the editorial assistance.
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The study has been conducted according to the principles of the Declaration of Helsinki, and it was approved by the Local Ethics Committee CEUR (Comitato Etico Unico Regionale, FVG, Italy) with approval number 115/2018. Each patient provided a written and signed informed consent that allowed the analysis of his/her data for clinical and research purposes.
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Granato, A., D’Acunto, L., Ajčević, M. et al. A novel computed tomography perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous aura stroke mimic. Neurol Sci 41, 3321–3328 (2020). https://doi.org/10.1007/s10072-020-04476-5
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DOI: https://doi.org/10.1007/s10072-020-04476-5