Cerebral Perfusion Changes in Hemiplegic Migraine Illustrated by Tc-99m ECD Brain Perfusion Scan

A 35-year-old man presented with reversible right-sided weakness and impaired verbal expression, followed by a pulsatile headache. Similar yearly attacks had occurred. Abnormally increased Tc-99m ethyl cysteinate dimer (ECD) activity in the left parieto-occipital region was noted during the phase of headache and normalized in the follow-up study. Ten months later, he had 2 episodes of left-sided numbness and headache. Tc-99m ECD during the aura phase revealed hypoperfusion at the right thalamus. Family history and genetic studies were negative, so sporadic hemiplegic migraine was concluded. Our report clearly demonstrated that Tc-99m ECD SPECT is an accurate assessment of brain perfusion changes in hemiplegic migraine. Copyright © 2010 by Lippincott Williams & Wilkins.