Clinical characteristics and perfusion-computed tomography alterations in a series of patients with migraine with aura attended as stroke code.

OBJECTIVE: The aim of the current study was to determine the clinical characteristics of migraine with aura (MA) as well as the frequency and patterns of perfusion-computed tomography (PCT) alterations, in a series of patients with MA mimicking acute ischemic stroke. BACKGROUND: MA is one of the most frequent stroke mimics, following seizures and psychiatric disorders. Previous case reports and short series have reported abnormal PCT patterns in patients with MA. METHODS: We conducted a retrospective cohort study including all consecutive patients presenting with focal neurological symptoms during complete multimodal CT including baseline CT, angio-CT, and PCT with a final diagnosis of MA. We collected demographic data and clinical information about MA variables using the hospital electronic database. RESULTS: We found 25 patients with a final diagnosis of MA among 1761 patients who attended our stroke center with complete multimodal CT (1.4% [95% CI: 0.9-2.1]). Among them, 14/25 (56%) were women, average age 38.7 years (SD 12.5), and 16/25 (64%) had a previous history of migraine. The most frequent type of aura was sensory. The median time elapsed between the onset of symptoms and CT was 171 min (IQR: 119-244). PCT alteration was found in 3/25 (12%) consisting of a hypoperfusion pattern not restricted to a vascular territory. The three patients had aphasia as the presenting symptom. CONCLUSION: This is, to the best of our knowledge, the largest series of patients with MA managed as presumed stroke with clinical characteristics and PCT. In our study, most patients were young and had a prior history of migraine. PCT was normal in 88% of cases, with patients being still symptomatic by the time they were scanned. Further research will clarify the presence and type of PCT alterations in this entity.

Predictors of perfusion computed tomography alterations in stroke mimics attended as stroke code.

BACKGROUND AND PURPOSE: Stroke mimics (SMs) account for a significant number of patients attended as stroke code (SC) with an increasing number over the years. Recent studies show perfusion computed tomography (PCT) alterations in some SMs, especially in seizures. The objective of our study was to evaluate the clinical characteristics and PCT alterations in SMs attended as SC in order to identify potential predictors of PCT alterations in SMs. METHODS: A retrospective study was performed including all SC activations undergoing a multimodal CT study including non-enhanced computed tomography (CT), CT angiography and PCT, as part of our SC protocol, over 39 months. Patients with a final diagnosis of SM after complete diagnosis work-up were therefore selected. Clinical variables, diagnosis, PCT alteration patterns and type of map affected (Tmax or time to peak, cerebral blood flow and cerebral blood volume) were registered. RESULTS: Stroke mimics represent up to 16% (284/1761) of SCs with a complete multimodal study according to our series. Amongst SMs, 26% (74/284) showed PCT alterations. PCT abnormalities are more prevalent in seizures and status epilepticus and the main pattern is alteration of the time to peak map, of unilateral hemispheric distribution or of non-vascular territory. In our series, the independent predictors of alteration in PCT in SMs are aphasia, female sex and older age. CONCLUSIONS: Perfusion computed tomography alterations can be found amongst almost a third of SMs attended as SC, especially older women presenting with aphasia with a final diagnosis of epileptic seizures and status epilepticus.