Right-to-left shunt and subclinical ischemic brain lesions in Chinese migraineurs: a multicentre MRI study

Jiang, Xiao-han; Wang, Si-bo; Tian, Qing; Zhong, Chao; Zhang, Guan-ling; Li, Yajie; Lin, Pang; You, Yong; Guo, Rong; Cui, Yunkang; Xing, Yingqi

doi:10.1186/s12883-018-1022-7

Cited by 16 publications

(20 citation statements)

References 34 publications

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“…The prevalence rate of DWMHs in our study was 58.2%, which is slightly higher than that reported in previous studies (7), despite the younger age (39.3 ± 11.7 years) of our participants. The overall prevalence of RLS in our study (48.5%) was similar to that of our previous work (46.1%) ( 10), but lower compared to other studies (9,18). Also, a higher prevalence rate of RLS in patients diagnosed with MwA, as reported in the literature (10,19), was not found in our study.…”

Section: Discussionsupporting

confidence: 85%

Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Xing

Zhang

Zhao

et al. 2021

Preprint

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BackgroundDeep white matter hyperintensities (DWMHs), often identified by hyperintense lesions on T2-weighted magnetic resonance imaging (MRI), were discovered to have a higher prevalence in migraine patients. A right-to-left shunt (RLS), which is also prevalent in migraineurs, could potentially contribute to the formation of DWMHs by induction of controversial embolism and endothelial dysfunction. In this cross-sectional study, we aim to evaluate the association between RLS and the prevalence of DWMHs in patients with migraine.MethodsIn this study, we consecutively enrolled patients with migraine aged between 18 and 50 years from the 14 headache clinics of participating hospitals. DWMHs were rated using Scheltens scale on digital MRI images obtained from 1.5T scanners, and RLS was detected via contrast-enhanced transcranial Doppler. Analyses on DWMH prevalence and loads by RLS grading or subtype were performed. A logistic regression analysis on DWMH prevalence was also performed.ResultsIn all, 237 migraine patients (age: 39.3 ± 11.7, 78.1% women, 13% migraine with aura) were enrolled. RLS was detected in 48.5% of the subjects and DWMHs were identified in 138 (58.2%) patients. Prevalence of DWMHs did not differ significantly between RLS+ (57.4%) and RLS− patients (59.0%, p = 0.74). No statistical difference in DWMH loads was found between different RLS grades or subtypes. Instead of RLS grades (p = 0.75), age (OR 1.067; 95%CI 1.034–1.101; p < 0.001) and aura (OR 4.063; 95%CI 1.492–11.061; p = 0.006) were statistically significant independent risk factors for increased DWMH prevalence in migraine patients.ConclusionsOur findings do not support an association between RLS and DWMHs in migraine patients, regardless of RLS grades or subtypes.Clinical Trial Registration: NCT 03418766; Date of registration: February 1, 2018

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Section: Discussionsupporting

confidence: 85%

Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Xing

Zhang

Zhao

et al. 2021

Preprint

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“…[10–12] Consistently, migraine patients may display an increased subclinical vascular burden at magnetic resonance imaging mainly in the posterior territory. [13] Nevertheless, recent reports refuted this finding, also in patients with right-to-left shunts (RLS)[14] or with migraine with aura [15]. Right-to-left shunts.…”

Section: Introductionmentioning

confidence: 99%

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura

et al. 2019

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Patent Foramen Ovale and impaired cerebral hemodynamics were proposed among the pathophysiological mechanisms explaining the increased risk for stroke in patients with Migraine with Aura (MA). Our study aimed at comparing the vasomotor reactivity (VMR) of the anterior and the posterior cerebral circulation in patients with Migraine with Aura, in patients with acute vascular ischemic accidents, and in controls. We hypothesized that VMR in MA patients is preserved in the anterior circulation and reduced in the posterior circulation. We prospectively assessed with Transcranial Doppler the vasomotor reactivity to breath holding of the Middle and Posterior Cerebral Arteries (MCA, PCA) in MA patients, in acute vascular patients and healthy controls. We also evaluated the possible effect of clinical characteristics of MA (attack frequency, aura length or type, disease history), vascular factors and the presence of right-to-left shunt on VMR. Diverging from our hypothesis, MA patients displayed a higher breath-holding index (BHI) than controls in the MCA (1.84±0.47%/s vs 1.53±0.47%/s, p = .001) as well as in the PCA (1.87±0.65%/s vs 1.47±0.44%/s, p < .001). In MA patients, MCA BHI was higher in those with large right-to-left shunts (2.09±0.42 vs 1.79±0.47, p = .046) and lower in those taking estrogens (1.30±0.30%/s vs 1.9±0.45%/s, p = .009). We did not observe an effect of MA characteristics on BHI. The increased BHI in MA patients with large right-to-left shunts could be explained by the vasoactive effect in the cerebral circulation of substances bypassing the deactivating pulmonary filters or by a constitutional trait of the vascular system associating persistent right-to-left shunts and hyper-reactive hemodynamics. Our results discourage the hypothesis that altered hemodynamics contribute to increasing the stroke risk in all MA patients. However, estrogens can lower VMR, curtailing the hemodynamic resources of MA patients.

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“…Some studies have had the opposite results. In 2018, a multicentre study involving 334 migraine patients in China found that right-to-left shunts were not associated with WMLs in migraine patients 17 . Another study conducted in 139 children and adolescents with migraine in the United States in 2013 showed that WMLs in migraine patients did not correlate to the existence of right-to-left shunts, the degree of rightto-left shunts, or the subtype of migraine 18 .…”

Section: Discussionmentioning

confidence: 99%

A Study on the Relationship Between Patent Foramen Ovale and White Matter Lesions in Migraine Patients

Huo¹,

Wan²,

Li³

et al. 2021

Preprint

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Background Migraine is a common clinical primary headache with unclear aetiology. In recent years, studies have shown that migraine is related to patent foramen ovale, and some patients with migraine have white matter lesions. However, the relationship among the three is unclear.Objective To explore the characteristics of white matter lesions (WMLs) in migraine patients with patent foramen ovale and to predict the occurrence of patent foramen ovale through magnetic resonance imaging (MRI) characteristics in patients with migraine.Methods Seventy-seven patients clinically diagnosed with migraine were examined by transcranial Doppler ultrasound (cTCD) and MRI. The patients were grouped according to the presence of WMLs, with matching by age, sex, hypertension, diabetes, PFO and other characteristic data. We observed the MRI fluid attenuation inversion recovery sequence (FLAIR) image and compared and analysed the difference in WMLs between the PFO-positive group and the PFO-negative group.Results There were 42 cases and 35 cases of migraine with and without WMLs, respectively. A statistically significant difference in near-cortical WMLs with PFO in migraine patients was observed (P=0.001). Logistic regression analysis adjusted by age, sex, hypertension and diabetes identified PFO status as the sole determinant for the presence of near-cortical WMLs (OR = 0.14; 95%CI 0.045–0.421; p < 0.001)Conclusion Near-cortical white matter lesions in migraine patients are related to PFO. Transcranial Doppler ultrasonography may reveal more PFO in patients with migraine and near-cortical WMLs.

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Right-to-left shunt and subclinical ischemic brain lesions in Chinese migraineurs: a multicentre MRI study

Cited by 16 publications

References 34 publications

Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura

A Study on the Relationship Between Patent Foramen Ovale and White Matter Lesions in Migraine Patients

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