Cerebral hyperperfusion on arterial spin labeling MRI during CADASIL migrainous encephalopathy

Migrainous encephalopathy is a rare and poorly understood manifestation of the inherited vasculopathy cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Patients may present with migraine with aura, complicated by confusion, fever, and decreased conscious level.1 In this case, a patient with migrainous encephalopathy underwent cerebral perfusion imaging with arterial spin labeling (ASL) MRI before, during, and following admission. Acknowledgment: The authors thank Dr. Rosario Lopez Gonzalez for writing the in house macro to allow quantitative analysis of ASL.