IGRAINE IS A COMMON, chronic, multifactorial neurovascular disorder typically characterized by recurrent attacks of disabling headache and autonomic nervous system dysfunction (migraine without aura); up to one third of patients also have neurological aura symptoms (migraine with aura). 1,2 Migraine has been suggested to be an independent risk factor for stroke, but the evidence is conflicting and seems to be restricted to certain subpopulations (eg, women with migraine with aura who are younger than 45 years, particularly ones who smoke or use oral contraceptives [OCs]). 3-9 Case reports on patients with so-called migrainous infarction suggest that the posterior circulation territory (PCT) is most commonly affected. 8,9 However, data are lacking on prevalence of subclinical infarcts in a wide spectrum of migraine patients in the general population. Patients with migraine may also be at increased risk of more diffuse subclinical lesions in the deep white matter or periventricular areas that are only detected on neuroimaging. 10-12 Several clinic-based magnetic resonance imaging (MRI) studies have reported this,

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Purpose To investigate whether the blood-brain barrier (BBB) leaks blood-circulating substances in patients with early forms of Alzheimer disease (AD), and if so, to examine the extent and pattern of leakage. Materials and Methods This study was approved by the local medical ethical committees of the Maastricht University Medical Center and Leiden University Medical Center, and written informed consent was obtained from all subjects. For this pilot study, 16 patients with early AD and 17 healthy age-matched control subjects underwent dynamic contrast material-enhanced magnetic resonance (MR) imaging sequence with dual time resolution for 25 minutes. The Patlak graphical approach was used to quantify the BBB leakage rate and local blood plasma volume. Subsequent histogram analysis was used to determine the volume fraction of the leaking brain tissue. Differences were assessed with linear regression analysis, adjusted for confounding variables. Results The BBB leakage rate was significantly higher in patients compared with that in control subjects in the total gray matter (P < .05) and cortex (P = .03). Patients had a significantly higher volume fraction of the leaking brain tissue in the gray matter (P = .004), normal-appearing white matter (P < .04), deep gray matter (P = .01), and cortex (P = .004). When all subjects were considered, scores on the Mini-Mental State Examination decreased significantly with increasing leakage in the deep gray matter (P = .007) and cortex (P < .05). Conclusion The results of this study showed global BBB leakage in patients with early AD that is associated with cognitive decline. A compromised BBB may be part of a cascade of pathologic events that eventually lead to cognitive decline and dementia. RSNA, 2016 Online supplemental material is available for this article.

We demonstrated a larger tissue volume with subtle BBB leakage in patients with cSVD than in controls. This was shown in the NAWM, WMH, and CGM, supporting the generalized nature of cSVD.