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Background: Hemiplegic migraine is a rare form of migraine with aura that includes motor weakness. Diagnosis during thefirst episode can be difficult to make and costly, especially with the sporadic form.Cases: Our study evaluates the ictal magnetic resonance imaging (MRI) features of four sequential pediatric patientsduring a first-time, sporadic hemiplegic migraine. Susceptibility-weighted imaging (SWI) revealed cerebral venous prominenceand increased magnetic susceptibility affecting brain regions that corresponded with each patient's neurologicdeficits. Repeat MRI (performed in three patients) following migraine recovery demonstrated resolution of all susceptibilityabnormalities.Conclusion: When combined with conventional MRI sequences, SWI has diagnostic value in the acute setting of motorweakness and with clinical features consistent with hemiplegic migraine. The sequence may help to further characterizeictal cerebral blood flow changes during the hemiplegic migraine aura. [ABSTRACT FROM AUTHOR]

The primary aim of this quality improvement initiative was to increase the number of patients receiving first-line therapy (adrenocorticotropic hormone, corticosteroids, vigabatrin) as the initial treatment for infantile spasms. We implemented a standardized management protocol for infantile spasms based on the best available data and expert consensus. To assess the impact of this intervention, we compared the 3-month remission rates between prestandardization (January 2009 to August 2012) and poststandardization (September 2012 to May 2014) cohorts. We found that the percentage of patients receiving first-line therapy as the initial treatment was 57% (31/54) in the prestandardization cohort and 100% (35/35) in the poststandardization cohort (P < .001). The rate of infantile spasms remission was higher poststandardization compared to prestandardization (78.8% vs 30.6%, P < .001). Management standardization led to all patients receiving first-line therapy as the initial treatment and was associated with a significantly improved rate of infantile spasms remission 3 months after diagnosis. [ABSTRACT FROM AUTHOR]