Hinal Parmar ¹ *, Sudhir Kothari ² , Deepak S Phalgune³ , Abhijit Wadekar ⁴ and Vivek Narayane⁴

¹ MBBS, DNB (Medicine), DrNB Neurology, Department of Neurology Poona Hospital and Research Centre, Pune, India
² MBBS, MD (Medicine), DM (Neurology), Professor and HoD, Department of Neurology, Poona Hospital and Research Centre, Pune, India
³ MBBS, MD, PhD, Research Consultant, Department of Research, Poona Hospital and Research Centre, Pune, India
⁴ MBBS, DNB (Medicine), Neurology Resident, Department of Neurology, Poona Hospital and Research Centre, Pune, India

*Corresponding Author: Hinal Parmar, MBBS, DNB (Medicine), DrNB Neurology, Department of Neurology Poona Hospital and Research Centre, Pune, India.

Received: February 27, 2026; Published: March 31, 2026

Abstract

Migraine with aura is associated with transient, dynamic alterations in cerebral perfusion related to cortical spreading depression, which may not be detected on conventional structural neuroimaging. Arterial spin labeling (ASL) magnetic resonance imaging (MRI) provides a non-invasive method for assessing these perfusion changes and can be particularly valuable in diagnosing and differentiating migraine with aura from other conditions. We report a 12-year-old boy who presented with exertion-triggered episodes of headache and transient focal neurological symptoms, initially raising diagnostic considerations of seizure, acute confusional migraine, and familial hemiplegic migraine. The electroencephalogram (EEG) showed unilateral slowing. During a subsequent episode, ASL performed at presentation demonstrated unilateral cortical hypoperfusion, followed by hyperperfusion on repeat imaging the next day, with complete normalization of perfusion within one week. Structural MRI remained normal throughout, and genetic testing for familial hemiplegic migraine was negative. Based on the clinical course, the complete reversibility of symptoms, and the characteristic temporal perfusion changes observed on serial ASL imaging, a final diagnosis of migraine with aura was established. This case highlights the utility of serial ASL MRI in capturing dynamic perfusion changes and supporting the diagnosis of migraine with aura when conventional imaging is unrevealing.

Keywords: Aura; Arterial Spin Labeling; Electroencephalogram; Migraine; Unilateral Hypoperfusion

References

1. Karsan N., et al. “Evaluating migraine with typical aura with neuroimaging”. Frontiers in Human Neuroscience 17 (2023): 1112790.
2. Schramm S., et al. “Perfusion imaging by arterial spin labeling in migraine: A literature review”. Journal of Cerebral Blood Flow and Metabolism8 (2024): 1253-1270.
3. Russo A., et al. “Arterial spin labeling MRI applied to migraine: current insights and future perspectives”. The Journal of Headache and Pain1 (2023): 71.
4. Haller S., et al. “Arterial spin labeling perfusion of the brain: emerging clinical applications”. Radiology2 (2016): 337-356.

Citation

Citation: Hinal Parmar., et al. “Beyond Conventional Magnetic Resonance Imaging: Arterial Spin Labeling in Migraine with Aura". Acta Scientific Neurology 9.4 (2026): 22-26.

Copyright

Copyright: ©2026 Hinal Parmar., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.