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A novel computed tomography perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous aura stroke mimic

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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.


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.


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.


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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Fig. 1

Similar content being viewed by others



Cerebral blood flow


Cerebral blood volume


Computed tomography


Computed tomography perfusion


Computed tomography angiography


Diffusion-weighted imaging


Emergency Department


Migrainous aura


Mean transit time


Magnetic resonance imaging


Non-enhanced CT


National Institutes of Health Stroke Scale


Region of interest


Stroke mimic


Stroke unit


Time to peak


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The authors thank Matteo di Franza for the editorial assistance.

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Correspondence to Laura D’Acunto.

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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).

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