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OBJECTIVE: To evaluate the role of Arterial Spin Labelling Perfusion Weighted Imaging(ASL-PWI) in Pediatric Hemiplegic Migraine.BACKGROUND: Most patients with hemiplegic migraines present with motor and sensoryphenomenon which mimic stroke like symptoms, often leading to emergent neuroimaging to ruleout acute stroke. While conventional MRI is typically unremarkable, supplementing with ASL-PWI provides vital insights into etiopathogenesis of hemiplegic migraine with clinico-radiological correlation and may alleviate the need for further work up.METHODS: After relevant IRB approval, 18 MRI brain studies performed for eventual clinicaldiagnosis of hemiplegic migraine were retrospectively reviewed by two pediatricneuroradiologists. While the standard MRI sequences were negative, the ASL PWI werecategorized into increased or decreased CBF (cerebral blood flow). After clinical chart review, 4patients were excluded for reasons such as- no subsequent follow up (1), absent motor symptoms(2), imaging limited due to artifacts (1) and ASL PWI not obtained (1).RESULTS:Mean age- 13.5 years (7 males and 6 females). All patients had normal MRI findings onconventional sequences (except 1 with SWAN abnormality) along with ASL perfusionabnormality corresponding to the neurodeficit (Refer to attached table for perfusioncharacteristics). Amongst the cohort, 10 patients demonstrated increased blood flow, and 3patients demonstrated decreased blood flow to the cerebral hemisphere contralateral to side of symptoms.CONCLUSIONS:ASL may should be obtained on all patients with concern for hemiplegic migraines as perfusionabnormalities will be missed on conventional sequences. It leads to minimal increase in scanduration, but its characterization of perfusion abnormalities may provide critical insights inunderstanding the pathogenesis of hemiplegic migraine with possible therapeutic implications.

Hemiplegic Migraines; MRI Brain;