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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
Published on: June 2, 2014
Right-to-left shunt does not increase white matter lesion load in migraine with aura patients
1Stroke Center, Neurology Department, Ospedale Sacro Cuore, via Sempreboni 6, 37024 Negrar-Verona, Italy. alessandro.adami@sacrocuore.it
Background:
White matter lesions (WMLs) are commonly found on brain MRI of migraine patients. Migraine with aura (MA+) is associated with an increased frequency of right-to-left shunt (RLS) mostly due to patent foramen ovale. The relationship between WML load and RLS in MA+ is currently unknown.
Methods:
MA+ patients were consecutively enrolled as part of the Shunt Associated Migraine (SAM) study. Patients underwent a standardized headache and vascular risk factors questionnaire, contrast-enhanced transcranial Doppler, blood coagulation tests, and brain MRI. RLS was categorized into four grades: no shunt, <10 microbubbles (mb), >10 mb single spikes pattern, and >10 mb shower/curtain pattern. Standard and fluid-attenuated inversion recovery T2-weighted MRI sequences were inspected for WMLs by three independent raters blinded to RLS grade. WML load was scored in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Scheltens scale. Interobserver agreement was good to excellent (kappa = 0.64 to 0.96, p < 0.0001). WML load was then correlated between patients with and without RLS.
Results:
One hundred eighty-five patients (77% women) were included. PV-WML load was similar between patients with and without RLS. D-WML load decreased in patients with RLS (p = 0.045). On logistic regression analysis, only age was associated with WMLs (p < 0.001).
Conclusions:
The presence of right-to-left shunt does not increase white matter lesion load in patients who have migraine with aura.
Insights
Right-to-left shunt (RLS) does not increase white matter lesion (WML) load in migraine with aura (MA+) patients. Deep white matter lesion load actually decreased in patients with RLS.
Area of Science:
- Neurology
- Neuroimaging
- Cardiology
Background:
- White matter lesions (WMLs) are common in migraine patients.
- Migraine with aura (MA+) is linked to increased right-to-left shunt (RLS) frequency, often due to patent foramen ovale.
- The association between WML load and RLS in MA+ remains unclear.
Purpose of the Study:
- To investigate the relationship between WML load and RLS in patients with MA+.
- To determine if RLS is a risk factor for increased WML burden in this population.
Main Methods:
- 185 MA+ patients were enrolled in the Shunt Associated Migraine (SAM) study.
- Patients underwent questionnaires, transcranial Doppler, coagulation tests, and brain MRI.
- WML load was assessed using Fazekas and Scheltens scales; RLS was graded.
- WML load was correlated with RLS presence and grade.
Main Results:
- Periventricular WML (PV-WML) load was similar in patients with and without RLS.
- Deep WML (D-WML) load showed a decrease in patients with RLS (p=0.045).
- Age was the only significant predictor of WMLs (p<0.001).
Conclusions:
- Right-to-left shunt presence does not elevate white matter lesion load in migraine with aura patients.
- The study suggests RLS is not associated with increased WML burden in MA+.
