• Grégoire Boulouis, Eimad Shotar, Volodia Dangouloff-Ros, David Grévent, Raphaël Calmon, Francis Brunelle, Olivier Naggara, Manoelle Kossorotoff, and Nathalie Boddaert.
• Pediatric Radiology Department, Hôpital Necker - Enfants Malades, INSERM UMR1163 and U1000, Institut Imagine, Université Paris Descartes - Sorbonne Paris Cité, Paris, France.
• Dev Med Child Neurol. 2016 Sep 1; 58 (9): 965-9.

AimAtypical migraine with aura can be challenging to diagnose. Arterial-spin-labelling (ASL) is able to non-invasively quantify brain perfusion. Our aim was to report cerebral blood flow (CBF) alterations using ASL, at the acute phase of atypical migraine with aura in children.MethodPaediatric patients were retrospectively included if (1) referred for acute neurological deficit(s), (2) underwent brain magnetic resonance imaging (MRI) at presentation with ASL sequence, and (3) had subsequent diagnosis of migraine with aura. Neurological symptom-free controls were matched for age. Twenty-eight regions of interest (ROIs) were drawn on CBF maps for each participant/control.ResultsTen patients were included (median age 13y, range 8-16y). Eight of 10 had multiple aura symptoms during the episode. For every patient, CBF was decreased in a brain region consistent with symptoms when MRI was performed less than 14 hours after onset (n=7 patients) and increased if the MRI was performed 17 hours or more after (n=4 MRIs).InterpretationMRI-ASL appears to be a promising tool for the diagnostic workup and differentials exclusion in paediatric migraine with aura. Constant and time-consistent non-territorial CBF modifications were found in our sample providing additional insight to migraine with aura pathophysiology. The authors encourage implementing this sequence at the acute phase of unexplained paediatric neurological deficits, with or without accompanying headache.© 2016 Mac Keith Press.

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