https://doi.org/10.1590/0004-282X20170162

IMAGES IN NEUROLOGY

Sulcal hyperintensity mimicking
subarachnoid hemorrhage in the context of
hemiplegic migraine
Hiperintensidade de sinal nos sulcos mimetizando hemorragia subaracnoide no contexto
de migrânea hemiplégica
Elton Francisco Pavan Batista1, Marcos Rosa Júnior1, Marcelo Ramos Muniz1

a familial autosomal dominant inheritance trait but, like our
patient, can be sporadic. An MRI can show cortical edema,
with sulcal hyperintensity on FLAIR (Figure), this being rare
and of uncertain etiology, possibly due to increased vascular permeability during the aura phase mimicking subarachnoid hemorrhage1,2,3.

A 31-year-old woman with migraine had reversible rightsided hemiplegia followed by a throbbing headache on the left
side, and underwent a series of MRI scans over an 18-day period.
Hemiplegic migraine is a rare subtype of migraine with
aura, presenting with a completely reversible unilateral
weakness associated with migraine. This disorder usually has

B

A

D

C

Figure. A) First MRI showed no abnormalities; B) Another MRI, one day later, revealed bilateral sulcal hyperintensity in FLAIR in the
brain convexities, reversible in the following control MRI; C) two weeks later; D) MR angiography was also normal.

References
1.

Russell MB, Ducros A. Sporadic and familial hemiplegic migraine:
pathophysiological mechanisms, clinical characteristics,
diagnosis, and management. Lancet Neurol. 2011;10(5):457-70.
https://doi.org/10.1016/S1474-4422(11)70048-5

3.

Bosemani T, Burton VJ, Felling RJ, Leigh R, Oakley C, Poretti
A et al. Pediatric hemiplegic migraine: role of multiple MRI
techniques in evaluation of reversible hypoperfusion. Cephalalgia.
2014;34(4):311-5. https://doi.org/10.1177/0333102413509432

2.

Gómez-Choco M, Capurro S, Obach V. Migraine with
aura associated with reversible sulcal hyperintensity
in FLAIR. Neurology. 2008;70(24 pt 2):2416-8.
https://doi.org/10.1212/01.wnl.0000314693.57386.f0

4.

Figure. A) First MRI showed no abnormalities; B) Another MRI, one
day later, revealed bilateral sulcal hyperintensity in FLAIR in the
brain convexities, reversible in the following control MRI; C) two
weeks later; D) MR angiography was also normal.

Universidade Federal do Espírito Santo, Departamento de Radiolodia, Vitória ES, Brasil.

1

Correspondence: Marcos Rosa Júnior; Centro de Ciências da Saúde da UFES; Av Marechal Campos, 1468; 29040-090 Vitória ES, Brasil.
E-mail: marcosrosajr@hotmail.com
Conflict of interest: There is no conflict of interest to declare.
Received 24 December 2016; Received in final form 11 August 2017; Accepted 28 August 2017.

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