Temporal Changes in Cerebral Blood Flow during Migraine with Aura of Alternating Left and Right Homonymous Hemianopsia.

A 16-year-old boy presented with sudden left homonymous hemianopsia followed by right ocular and occipital pain. Arterial spin labeling (ASL), a non-contrast magnetic resonance imaging technique used to evaluate perfusion, showed a decrease in cerebral blood flow in the right occipital lobe. Three hours after admission, the patient experienced right homonymous hemianopsia and ocular-to-occipital pain on the contralateral side. ASL revealed a decreased cerebral blood flow in the left occipital lobe. We ultimately diagnosed the patient with first-time migraine with aura, in which cortical spreading depression was visualized as decreased cerebral blood flow using ASL.