Crossed Cerebellar Diaschisis May Be Benign in Migraine With Aura

Although common, cerebellar hypoperfusion and crossed cerebellar diaschisis appear to be benign in people with migraine with aura, according to a retrospective study published in the American Journal of Neuroradiology.

In this study, investigators analyzed 106 patients with migraine who underwent magnetic resonance imaging and dynamic susceptibility contrast perfusion. A regions-of-interest analysis was performed in patients with apparent perfusion asymmetry across 18 infratentorial and supratentorial regions of interest.

For the purposes of this study, a >10% presence of cerebellar hypoperfusion was considered significant. Within 24 hours of the onset of migraine symptoms, participants underwent a dedicated stroke protocol. Of the 106 participants, 98 received a final diagnosis of migraine with aura.

Among the entire cohort, a total of 23 participants had observable perfusion asymmetries. The mean time between onset of symptoms and imaging was 212 minutes. Of the patients with perfusion asymmetries, 22 (20.8%) had migraine with aura. Approximately half of these patients (n = 12) had cerebellar diaschisis, whereas 39.1% (n=9) had abnormal perfusion. Overall, none of the patients in the cohort had diffusion-weighted imaging restrictions during migraine with aura.

Investigators included no healthy control group in this analysis with which to compare the small number of people with migraine with aura, potentially limiting the findings of this study. The researchers also note that rater-dependent bias may have been present because of the use of expert analysis in selecting apparent perfusion deficits among those with migraine.

These findings are contrary to prior hypotheses that inferred an increased risk for hypoxic cerebellar infarctions in the setting of cerebellar hypoperfusion.

According to the investigators, “Crossed cerebellar diaschisis in migraine with aura may be considered a benign phenomenon because we observed no association with [diffusion weighted imaging] restriction or manifest cerebellar infarctions.”

Reference

Kellner-Weldon F, El-Koussy M, Jung S, Jossen M, Klinger-Gratz PP, Wiest R. Cerebellar hypoperfusion in migraine attack: incidence and significance [published online January 11, 2018]. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A5508