Background: Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. Our research aims to study the correlation of migraine type, attack frequency, and other clinical variables with the presence, volume and localization of white matter lesions (WML), in a controlled study. Methods: Sixty volunteers from a tertiary headache center were selected and divided equally into four groups: episodic migraine without aura (MoA), episodic migraine with aura (MA), chronic migraine (CM) and controls (CG). Voxel-based morphometry techniques were used to analyze WML. Results: There were no differences in WML variables between groups. There was a positive correlation between age and the number and total volume of WMLs, which persisted in the comparison categorized by size and brain lobe. Disease duration was positively correlated with the number and total volume of WML, and when controlled by age, the correlation maintained significance only for the insular lobe. Aura frequency was associated with frontal and temporal lobe WMLs. There was no statistically significant correlation between WML and other clinical variables. Conclusion: Migraine overall is not a risk factor for WML. Aura frequency is, however, associated with temporal WML. Disease duration, in adjusted analyses that account for age, is associated with insular WML.

Background Migraine was previously interpreted as “benign” disease since the major part of patients were asymptomatic between attacks and brain lesions are absent in primary headaches. Advances in structural neuroimaging have changed this point of view. Voxel-based-morphometry is an accurate technique to evaluate objectively structural brain damage. Our hypothesis was that some clinical features of migraine, as aura and attack frequencies, are more related to volumetric changes in migraineurs brains.    Objectives To compare brain lobes volumetry between migraine patients (episodic migraine, with and without aura, chronic migraine) and healthy controls. To evaluate the correlations of brain volumetric variables with clinical variables.   Methods This is a cross-sectional study performed with 60 female volunteers, aged between 18 and 55 years old, equally allocated into four groups: episodic migraine without aura, episodic migraine with aura, chronic migraine and controls. The sample was clinically characterized by the following variables: age, number of days with headache in the last month, number of days with aura in the last month, average pain intensity in the last month, disease duration calculated in number of years from the migraine diagnosis to the MRI performance, and the use of prophylactic drugs for migraine. Volunteers underwent brain MRI, and Free Surfer software was used to perform volumetric studies. Statistical analyses included Mann-Whitney test, Kruskal-Wallis test, Dunn test and Spearmann correlations.   Results No statistically relevant differences were found in cerebral lobe volumes and supratentorial white matter in the comparison between groups. Regarding to clinical correlations, age influenced the brain lobes volumetric reduction, as expected, except for the parietal lobe, for which the correlation was not important. The disease duration was correlated with the reduction of the frontal (p<0.001 / r=-0.531), temporal (p=0.003/r=-0.433), parietal (p=0.004/r=-0.431) lobes; when adjusted by age...   (To see the complet abstract, please, check out the PDF.)

Case report: A previously healthy 60-year-old woman presented to the dermatology clinic for a deep phenol peeling. A few minutes after the procedure, she had become confused and disoriented, so the neurology clinic was called. On the neurological assessment, the patient kept asking her sister where she was and how she got to the hospital. It was noted that the patient had deep anterograde amnesia and retrograde amnesia ranging from a few hours before the arrival at the hospital, with preserved episodic and semantic memories. The remainder of the neurologic exam was normal. She was submitted to basic laboratory evaluation, which showed no abnormalities. Brain magnetic resonance imagin showed a mild FLAIR (Fluid-Attenuated Inversion Recovery) hyperintensity on the left medial temporal lobe, without signal alterations in the DWI (diffusion-weighted imaging) image. After about 4 hours of the onset, the disorientation had resolved and she was discharged after 24 hours of observation, asymptomatic. Discussion: Phenol peeling is the most aggressive of all peels, and as this substance is absorbed by the skin, metabolized by the liver, and excreted by urine it is associated with systemic complications, such as cardiac arrhythmias and acute kidney injury. There are no previous reports of the occurrence of a transient global amnesia (TGA) episode after such a procedure, although it is known that it can be precipitated by physical exertion and psychological stress. The pathophysiology of a TGA episode is thought to be related to metabolic stress to the CA-1 subfield of the hippocampus. Although the association is unclear, we can make an assumption that phenol could have a disruptive metabolic effect on this particular brain area. Conclusion: We report a case of TGA preceded by a deep phenol peeling. Although it is impossible to establish causality in this case, it is important that the neurologist be aware that certain medical conditions, procedures and substance administration can be associated with TGA.