Role of Arterial Spin Labelling Perfusion weighted MRI in evaluation of children with hemiplegic migraine.

Objective: To evaluate utility of Arterial Spin Labelling Perfusion weighted MRI in children with hemiplegic migraine. Background: Patients with hemiplegic migraines usually presents with aura including motor, sensory, visual or language symptoms that are completely reversible. Given their sudden onset that could last up to 24 hrs, physicians often order MRI of the brain in order to rule out stroke as the etiology of symptoms. ASL is a MR perfusion technique the exploits arterial water as a freely diffusible tracer for quantitative measurement of cerebral blood flow. Design/Methods: MRI brain exams were reviewed in 22 children with clinical concern for hemiplegic migraine retrospectively. ASL sequences were assessed for perfusion abnormalities- hyper perfusion (increased ASL) or hypoperfusion (decreased ASL) by two Pediatric Neuroradiologists in conjunction with conventional MRI. Patients with structural brain abnormalities, brace artifact, and without motor weakness were excluded from study. All patients had normal findings on conventional sequences. Results: MRI brain studies on 13 children were analyzed for hyper or hypoperfusion on ASL sequences. Time to scan from onset of symptoms was around 7 hrs. ASL sequencing was abnormal (either decreased or increased ASL) in all patients. Conclusions: This is the first study to show abnormal perfusion on ASL in children with hemiplegic migraine. This is a preliminary data as study is still ongoing. Characterization of perfusion abnormalities may provide critical insights in understanding the pathogenesis of hemiplegic migraine with possible therapeutic implications. Study Supported by: None Disclosure: Dr. Patil has nothing to disclose. Dr. Nikam has nothing to disclose. Dr. Jain has nothing to disclose. Dr. Kandula has nothing to disclose.