Migraine with aura associated with unilateral cortical increase in vascular permeability

Background: Few studies to date have captured perfusion and vascular permeability changes during a migraineur's aura. This may be important information to the clinician in the context of the differential diagnosis of migraine with aura versus acute stroke. Summary: We report a case in which magnetic resonance perfusion during a migraine aura showed unilateral hypoperfusion differentially affecting gray and white matter and was associated with a hemispheric increase in permeability. Conclusions: Imaging in this case suggests that migraine aura is associated with oligemia below the threshold for infarction. Increased vascular permeability may be a critical mechanism contributing to perfusion changes observed in migraine with aura.