Cerebral Hemodynamics, Right-to-Left Shunt and White Matter Hyperintensities in Patients with Migraine with Aura, Young Stroke Patients and Controls

Abstract

Background: Migraine with aura (MA) patients present an increased risk of cerebrovascular events. However, whether these patients present an increased white matter hyperintensities (WMHs) load compared to the general population is still under debate. Our study aimed to evaluate the relationship between cerebral hemodynamics, right-to-left shunt (RLS) and WMHs in MA patients, young patients with cryptogenic stroke or motor transient ischemic attack (TIA) and controls. Methods: We enrolled 30 MA patients, 20 young (<60 years) patients with cryptogenic stroke/motor TIA, and 10 controls. All the subjects underwent a transcranial Doppler bubble test to detect RLS and cerebral hemodynamics assessed by the breath holding index (BHI) for the middle (MCA) and posterior (PCA) cerebral arteries. Vascular risk factors were collected. The WMHs load on FLAIR MRI sequences was quantitatively assessed. Results: The stroke/TIA patients presented a higher prevalence of RLS (100%) compared with the other groups (p < 0.001). The MA patients presented a higher BHI compared with the other groups in the PCA (p = 0.010) and higher RLS prevalence (60%) than controls (30%) (p < 0.001). The WMHs load did not differ across groups. BHI and RLS were not correlated to the WMHs load in the groups. Conclusions: A preserved or more reactive cerebral hemodynamics and the presence of a RLS are likely not involved in the genesis of WMHs in MA patients. A higher BHI may counteract the risk related to their higher prevalence of RLS. These results need to be confirmed by further studies to be able to effectively identify the protective role of cerebral hemodynamics in the increased RLS frequency in MA patients.

PFO-spectrum disorder: two different cerebrovascular diseases in patients with PFO as detected by AI brain imaging software

“…It has been proposed that patients with RLS may exhibit varying degrees of cerebrovascular reactivity (CVR), which could influence the burden of WM lesions. While some studies suggest that CVR has no role in the WM lesional burden in patients with RLS ( 21 ), other research indicates that patients with RLS who exhibit WM lesions tend to have lower CVR compared to those without RLS or WM lesions ( 22 ). Additionally, a decreased CVR was also shown to be linked to WM lesional development in patients with migraine, but in these patients, age was the major determinant of the WM lesional volume ( 23 ).…”

“…Nevertheless, recent studies have described additional factors that may contribute to the occurrence of PFO-associated cerebrovascular disease. Notably, patients with PFO have been found to exhibit endothelial dysfunction as evidenced by alterations in the L-arginine/ADMA ratio (18), reduced fibrinolytic activity (19), but also increased levels of total circulating homocysteine serum levels (20).…”