Susceptibility-weighted imaging and computed tomography perfusion abnormalities in diagnosis of classic migraine

For the radiologist in the emergency department setting, the accurate diagnosis of acute neurologic change can be challenging—an incorrect or delayed diagnosis can lead to poor outcomes for the patient and potential medicolegal jeopardy. Conditions such as stroke, seizure, and infection are often first considered, as failure to promptly treat these entities can result in high morbidity or mortality. Migraine with aura is associated with neurologic change, most often visual in nature, including scotomas, visual field deficits, and visual hallucinations. However, any neurologic change can occur, including motor, sensory, or verbal deficits, which may mimic signs and symptoms of an acute stroke As neuroimaging is a part of the diagnostic and treatment decision-making process, the radiologist must be aware of the wide range of imaging findings of both common and uncommon etiologies for changes in neurologic status. In this paper, we present a case of an atypical presentation of migraine with aura diagnosed with susceptibility-weighted imaging and computed tomography perfusion.