Dilatação dos espaços de Virchow-Robin em pacientes com migrânea

Abstract

No passado, acreditava-se que os espaços de Virchow-Robin (EVR) eram invaginações dos espaços subaracnóides 1,2 . Estudos com microscopia eletrôni-ca, sugerem que os EVR originam-se de invaginações do espaço subpial, formando uma bainha de revestimento que contém as artérias separando o espaço subaracnóide do subpial 3,4 .A dilatação dos EVR é facilmente detectada pela ressonância magnética (RM) 5 e tem sido descrita em pacientes com criptococose 6 , mucopolissacaridose 7 , crianças com cefaléia 8 , envelhecimento 9 macrocefalia e epilepsia do lobo temporal 10 ou ainda, em achados ocasionais concebidos como variantes do normal 11,12 .Nós revimos 70 RM de pacientes com migrânea e comparamos com igual número de pacientes sem antecedentes de cefaléia. RESUMO -Os espaços de Virchow-Robin (EVR) são invaginações do espaço subpial, formando uma bainha de revestimento tubular contendo um vaso, que separa o espaço subaracnóide do subpial. A ressonância magnética (RM) é o único método de imagem capaz de avaliar este detalhe anatômico. Nós estudamos a possível associação entre EVR dilatados e migrânea. Avaliamos 70 pacientes com idade compreendida entre 13 e 54 anos (média 36,5 anos), com diagnóstico clínico de migrânea e comparamos com grupo controle com igual número de pacientes com idade compreendida entre 14 e 64 anos (média de 42 anos), sem antecedentes de cefaléia. Observamos aumento dos EVR em 28 casos (40%) dos pacientes com migrânea. No grupo controle tal achado foi encontrado em apenas 5 casos (7,1%). Alertamos, ainda, sobre a importância na detecção e reconhecimento dos EVR, bem como o seu diagnóstico diferencial com infartos lacunares e cistos da fissura coroidea. PALAVRAS-CHAVE: espaços perivasculares de Virchow-Robin, ressonância magnética, migrânea. DILATAÇÃO DOS ESPAÇOS DE VIRCHOW-ROBIN EM PACIENTES COM MIGRÂNEA Dilatation of Virchow-Robin spaces in patients with migraineABSTRACT -The Virchow-Robin spaces (VRS) are subpial invaginations making a tubular revestment scabbard that contains a vase between the subarachnoid and subpial spaces. The magnetic resonance imaging (MRI) is the only imaging method able for evaluate this anatomic detail. We studied the possible association between dilated VRS and migraine. Seventy patients with ages ranging from 13 to 54 years (mean, 36.5 years), with clinical diagnosis of migraine were studied and compared with a control group, without past of headache, composed by the same number of patients with ages ranged from 14 to 64 years (mean, 42 years). We observed widening of VRS in 28 cases (40%) of the migraine patients. In the control group this feature was demonstrated in only 5 cases (7.1%). Alert for the importance of detecting and recognizing the VRS, as well as, the diferentiation from lacunar infarctions and coroid fissure cists.

Enlarged perivascular spaces in patients with migraine: a case–control study based on 3T MRI

“…Our study, which utilized a 3T MRI device to investigate the Chinese adult migraine population, is consistent with two earlier studies that used a 1.5T MRI device, indicating the involvement of EPVS in migraine. For instance, the first study focused on a migraine population aged 13–56 years and observed a widening of the VRS in 28 (40.00%) patients with migraine compared with only 5 (7.10%) in the controls 15 . Moreover, the second study observed accentuated VRS in 61.00% of children with migraine aged 3–14 years, but only in 22.00% of children with TTH and 27.00% of children without headaches 16 .…”

“…Normal PVS are not visible on MRI; MRI‐visible enlarged perivascular spaces (EPVS) provide us with a non‐invasive method of indirectly reflecting the dysfunction of glymphatic drainage, 14 which could be widely used in clinical practice. Several prior studies have focused on the relationship between EPVS and migraine 15–18 . For instance, one of these studies found that accentuated Virchow‐Robin spaces (VRS) were significantly more common in children with migraine than in those with tension‐type headache (TTH) or headache‐free controls 16 .…”

Structural MRI in Migraine: A Review of Migraine Vascular and Structural Changes in Brain Parenchyma

“…A study by Machado Jr. et al (2001) found that between equal numbers of age-matched patients suffering from migraine of unspecified subtypeand and headache-free controls ranging from adolescence to middle age, 40% of migraine patients showed enlarged PVS compared to only 7.1% of controls. 49 After comparing migraine of unspecified subtype in pediatric patients to adult patients with post-pubertal migraine onset, Schick et al (1999) showed that 61% of pediatric migraineurs had larger clusters of PVS compared to only 27% of pediatric controls and 13% adult migraineurs. 6 In contrast to these findings and other prior studies, a more recent investigation by Husøy et al (2016) discovered a decrease in PVS quantity for MWoA patients in the basal ganglia (BG) and hemispheric white matter (HWM); additionally, they showed only small differences in PVS number between headache groups and headache-free patients, as well as finding no significant association between PVS and headache category, frequency, or disease duration.…”

Correlation between migraine and cerebral small vessel disease: A case–control study

“…The correlation between migraine and VRSs has rarely been studied previously, and only two studies have investigated the relationship between migraine and VRSs in (Husøy et al, 2016;Machado et al, 2001a). Machado et al first found that there were more expanded VRSs in migraineurs than in normal controls (Machado et al, 2001a).…”

“…The correlation between migraine and VRSs has rarely been studied previously, and only two studies have investigated the relationship between migraine and VRSs in (Husøy et al, 2016;Machado et al, 2001a). Machado et al first found that there were more expanded VRSs in migraineurs than in normal controls (Machado et al, 2001a). In contrast, the HUNT-MRI study found no significant difference between the migraine and control groups, and even fewer VRS numbers in migraineurs without aura than in controls (Husøy et al, 2016).…”