Brain, Vol. 110, No. 4, 917-959, 1987
© 1987 Guarantors of Brain
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FOCAL ISCHAEMIA CAUSED BY INSTABILITY OF CEREBROVASCULAR TONE DURING ATTACKS OF HEMIPLEGIC MIGRAINE: A REGIONAL CEREBRAL BLOOD FLOW STUDY1
Department of Clinical Physiology and Nuclear Medicine, and the Department of Neurology, Bispebjerg Hospital Copenhagen, Denmark
Correspondence to:
Correspondence to: Dr Lars Friberg, Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, DK-2400 Copenhagen NV, Denmark.
During the course of hemiplegic migraine in 3 patients, changes in regional cerebral blood flow (rCBF) were recorded by the intracarotid l33Xe method and a 254 multidetector camera covering one hemisphere. The rCBF measurements were performed in conjunction with cerebral angiography. During repeated rCBF measurements all 3 patients developed focal hypoperfusion originating in the frontal lobe, subsequently spreading posteriorly to involve the precentral and postcentral regions. In 2 cases focal hyperperfusion appeared to precede the hypoperfusion. In association with the rCBF changes the patients developed transient motor and/or sensory deficits and subsequently severe headache. No signs of arterial occlusion were found.
In the over and underperfused regions blood flow fluctuated rapidly because of instability of cerebrovascular tone, defined as transient constriction of the smallest cerebral vessels (arterioles) alternating with a normal calibre for these vessels and/or short periods of vasodilatation. It is considered to be a primary pathological condition of the vessels.
When vasoconstriction was present the blood flow decreased to values consistent with ischaemia, which was probably the cause of the neurological deficits. On the basis of these observations and previous work from our laboratory we conclude that instability of cerebrovascular tone may cause focal ischaemia during the course of attacks of classical and hemiplegic migraine.
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Received May 13, 1986. Revised September 30, 1986. Accepted October 28, 1986.
1Preliminary reports on parts of this study were given at the XII International Symposium on Cerebral Blood Flow and Metabolism, Lund, Sweden, and the Second International Headache Congress, Copenhagen, Denmark, both held in June 1985.
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