technetium-tc-99m-exametazime and Migraine-without-Aura

The aim of the study was to evaluate the regional cerebral blood flow (rCBF) occurring interictally in children with migraine using SPECT The study included 30 patients (16 boys and 14 girls) aged 8-16 with migraine with and without aura during attacks. SPECT scans were performed after i. v. injection of 99mTc-ECD of 0.3 mCi/kg b.m. Uptake of the tracer was determined in different regions of interest in the cortex. 11 patients showed homogenous distribution over all cortical regions and rCBF expressed as a cerebral/cerebellar ratio was within the normal range. Reduced perfusion and asymmetry ranging between the right and left hemisphere within 7-10% was observed in 19 out of 30 patients with migraine attacks. In all these 19 cases we observed localization of hypoperfused foci in SPECT imaging matched with the side of migraine pain.. The interictal rCBF is both reduced and asymmetric in children suffering from migraine and the side of migraine pain is in accordance with the localization of hypoperfusion in SPECT.

Topics: Adolescent; Cerebrovascular Circulation; Child; Female; Humans; Male; Migraine with Aura; Migraine without Aura; Radiopharmaceuticals; Reference Values; Severity of Illness Index; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Ultrasonography

The aim of the present study was to compare cranial arteries blood flow velocity as measured by means of transcranial Doppler sonography (TCD) with mean regional cerebral blood flow (rCBF) as measured by means of single photon emission computed tomography (SPECT) in migraine with and without aura during headache-free periods and spontaneous and/or induced attacks.. Regional cerebral blood flow (rCBF) and systematic ultrasonic Doppler flow were studied by Technetium-99m hexamethylpropilaminoxime (99mTc-HM-PAO) single photon emission computed tomography (SPECT) and transcranial Doppler sonography (TCD) respectively in controls (n=14) and in migraine with (n=13) and without aura (n=35) during headache free-intervals and spontaneous/histamine-induced attacks.. In the migraine without aura group, Doppler flow examinations of the common carotid artery, external and internal carotid artery, ophthalmic artery and middle cerebral artery bilaterally did not reveal significant changes as compared with controls. During attacks, TCD examinations showed a moderate, although not statistically significant, reduction of blood flow velocity in the middle cerebral artery and in the internal carotid artery bilaterally as related to the interictal phase, concomitant with an increase of the flow velocity in the ophthalmic and external carotid artery. SPECT of these patients did not show, on the average, rCBF asymmetries during pain-free periods, although positive findings (i.e., focal hypoperfusion) were found in approximately half of the cases. During attacks, 74% of patients displayed a unilateral hypoperfusion, mainly in the occipital region. Low-flow areas were generally but not always consistent with the site of pain. In the migraine with aura group, significant reduction of blood flow velocity in middle cerebral artery was recorded by TCD on the affected side during attacks, as compared with the pain-free side. Hypoperfusion was registered between attacks by SPECT in approximately 2/3 of the patients. During attacks, a marked reduction of rCBF occurred in most patients (85%), mainly in the parieto-occipital region. The posterior rCBF asymmetries revealed at the SPECT and consistent with the general reduction of blood flow velocity documented by TCD may be related to cerebrovascular tone instability.. Our findings do not support the paradigm that migraine with and without aura are two different entities.

Topics: Adult; Carotid Arteries; Cerebrovascular Circulation; Female; Humans; Male; Migraine with Aura; Migraine without Aura; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Ultrasonography