Livedo Reticularis and Migraine: A Marker for Stroke Risk?

Abstract

In our headache clinic, livedo reticularis is present in more than one fifth of patients. A history of stroke is more frequent in this subset of migraineurs, raising the possibility that livedo reticularis can be used as a clinical marker to identify those migraineurs with an increased risk of stroke.

The spectrum of differential diagnosis in neurological patients with livedo reticularis and livedo racemosa

“…Data suggest that it is under-diagnosed [93] with the expected incidence of cases to be 4 per 1 million per annum [109]. It has been estimated that the disorder occurs in about 1:2000 stroke patients [97,98]. It must be stressed that the prognosis in patients with SS is poor compared with young patients with cerebral infarction [10,103].A mortality rate of 9.5% was reported in a mean observation period of 6.2 years [109].…”

“…Most of patients with SS have suffered from migraine for a long time. The working group of Tietjen et al pointed out that livedo racemosa is significantly linked with migraine and this association seems to be a marker for stroke risk [97,98].…”

“…Livedo racemosa may be a rare cutaneous manifestation in haematological diseases such as essential thrombocythemia [6,42], polycythemia vera [27], pernicious anaemia [86] and disseminated intravascular coagulation [97,98]. More often, livedo racemosa is associated with essential and secondary cryofibrogenemia [8,34,65,101].…”

“…Some authors have reported the rare cutaneous manifestation of livedo racemosa in rheumatoid arthritis, Sjogren syndrome, dermatomyositis, scleroderma and arteriitis temporalis [88,97,98,107]. In these associations an overlap syndrome has to be suspected.…”

Migraine and Ischemic Stroke: A Debated Question

“…Hormonal status seems to play a pathogenic role in the development of MO, but not of MA, which, as a matter of fact, represents the situation where the incidence of ischemic stroke is higher (Bousser, 2004). Inconsistent results have also been found for the various biologic or clinical markers of thrombotic risk studied so far (Crassard et al, 2001;Kern, 2004), such as platelet activation, factor V Leiden mutation (Soriani et al, 1998), von Willebrand factor (Tietjen et al, 2001), prothrombin factor 1.2 (Hering-Hanit et al, 2001), platelet leukocyte aggregation (Zeller et al, 2004), antiphospholipid antibodies (Cervera et al, 2002;Tietjen et al, 1998), and livedo reticularis (Tietjen et al, 2002).…”