Right-to-left Shunt and Subclinical Ischemic Brain Lesions in Chinese Migraineurs: a Multicentre MRI Study

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2018 Feb 16

PMID 29444659

Citations 9

Authors

Xiao-Han Jiang

Si-Bo Wang

Qian Tian

Chi Zhong

Guan-Ling Zhang

Ya-Jie Li

Pan Lin

Yong You

Rong Guo

Ying-Hua Cui

Ying-Qi Xing

Affiliations

Soon will be listed here.

Abstract

Background: Migraine is considered as a risk factor for subclinical brain ischemic lesions, and right-to-left shunt (RLS) is more common among migraineurs. This cross-sectional study assessed the association of RLS with the increased prevalence of subclinical ischemic brain lesions in migraineurs.

Methods: We enrolled 334 migraineurs from a multicentre study from June 2015 to August 2016. Participants were all evaluated using contrast-enhanced transcranial Doppler, magnetic resonance imaging (MRI), and completed a questionnaire covering demographics, the main risk factors of vascular disease, and migraine status. RLS was classified into four grades (Grade 0 = Negative; Grade I = 1 ≤ microbubbles (MBs) ≤ 10; Grade II = MBs > 10 and no curtain; Grade III = curtain). Silent brain ischemic infarctions (SBI) and white matter hyperintensities (WMHs) were evaluated on MRI.

Results: We found no significant differences between migraineurs with RLS and migraineurs without RLS in subclinical ischemic brain lesions.SBI and WMHs did not increase with the size of the RLS(p for trend for SBI = 0.066, p for trend for WMHs = 0.543). Furthermore, curtain RLS in migraineurs was a risk factor for the presence of SBI (p = 0.032, OR = 3.47; 95%CI: 1.12-10.76). There was no association between RLS and the presence of WMHs.

Conclusion: Overall, RLS is not associated with increased SBI or WMHs in migraineurs. However, when RLS is present as a curtain pattern, it is likely to be a risk factor for SBIs in migraineurs.

Trial Registration: No. NCT02425696 ; registered on April 21, 2015.

Citing Articles

Analysis of the relationships between the degree of migraine with right-to-left shunts and changes in white matter lesions and brain structural volume.

Pan X, Ren H, Xie L, Zou Y, Li F, Sui X Sci Rep. 2025; 15(1):1145.

PMID: 39774196 PMC: 11707276. DOI: 10.1038/s41598-025-85205-w.

Relationship between right-to-left shunt and white matter lesions in patients with migraine: a single-center study.

Liu Z, Jiang M, He J, Lin Y, He L, Li Y Front Neurol. 2024; 15:1419533.

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The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview.

Liu F, Yao Y, Zhu B, Yu Y, Ren R, Hu Y Front Med (Lausanne). 2024; 11:1269742.

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Recent progress in patent foramen ovale and related neurological diseases: A narrative review.

Shi F, Sha L, Li H, Tang Y, Huang L, Liu H Front Neurol. 2023; 14:1129062.

PMID: 37051056 PMC: 10084837. DOI: 10.3389/fneur.2023.1129062.

Evaluating the relationship between right-to-left shunt and white matter hyperintensities in migraine patients: A systematic review and meta-analysis.

Yeo J, Goh C, Tan Y, Sim B, Chan B, Syn N Front Neurol. 2022; 13:972336.

PMID: 36061988 PMC: 9433673. DOI: 10.3389/fneur.2022.972336.

References

Feurer R, Sadikovic S, Esposito L, Schwarze J, Bockelbrink A, Hemmer B . Lesion patterns in patients with cryptogenic stroke with and without right-to-left-shunt. Eur J Neurol. 2009; 16(10):1077-82. DOI: 10.1111/j.1468-1331.2009.02692.x. View

Schwerzmann M, Nedeltchev K, Lagger F, Mattle H, Windecker S, Meier B . Prevalence and size of directly detected patent foramen ovale in migraine with aura. Neurology. 2005; 65(9):1415-8. DOI: 10.1212/01.wnl.0000179800.73706.20. View

Lee M, Lee C, Chung C . The Migraine-Stroke Connection. J Stroke. 2016; 18(2):146-56. PMC: 4901947. DOI: 10.5853/jos.2015.01683. View

Xu W, Xing Y, Yan Z, Jiang J, Gao S . Cardiac right-to-left shunt subtypes in Chinese patients with cryptogenic strokes: a multicenter case-control study. Eur J Neurol. 2014; 21(3):525-8. DOI: 10.1111/ene.12351. View

Gaist D, Garde E, Blaabjerg M, Nielsen H, Kroigard T, Ostergaard K . Migraine with aura and risk of silent brain infarcts and white matter hyperintensities: an MRI study. Brain. 2016; 139(Pt 7):2015-23. PMC: 4939694. DOI: 10.1093/brain/aww099. View

Bednarczyk E, Remler B, Weikart C, Nelson A, Reed R . Global cerebral blood flow, blood volume, and oxygen metabolism in patients with migraine headache. Neurology. 1998; 50(6):1736-40. DOI: 10.1212/wnl.50.6.1736. View

Kruit M, van Buchem M, Hofman P, Bakkers J, Terwindt G, Ferrari M . Migraine as a risk factor for subclinical brain lesions. JAMA. 2004; 291(4):427-34. DOI: 10.1001/jama.291.4.427. View

Kurth T, Mohamed S, Maillard P, Zhu Y, Chabriat H, Mazoyer B . Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study. BMJ. 2011; 342:c7357. PMC: 3022913. DOI: 10.1136/bmj.c7357. View

Scher A, Gudmundsson L, Sigurdsson S, Ghambaryan A, Aspelund T, Eiriksdottir G . Migraine headache in middle age and late-life brain infarcts. JAMA. 2009; 301(24):2563-70. PMC: 3133433. DOI: 10.1001/jama.2009.932. View

10.

Guo Z, Xing Y, Liu J, Wang S, Yan S, Jin H . Compromised dynamic cerebral autoregulation in patients with a right-to-left shunt: a potential mechanism of migraine and cryptogenic stroke. PLoS One. 2014; 9(8):e104849. PMC: 4133257. DOI: 10.1371/journal.pone.0104849. View

11.

Swartz R, Kern R . Migraine is associated with magnetic resonance imaging white matter abnormalities: a meta-analysis. Arch Neurol. 2004; 61(9):1366-8. DOI: 10.1001/archneur.61.9.1366. View

12.

Anzola G, Magoni M, Guindani M, Rozzini L, Dalla Volta G . Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology. 1999; 52(8):1622-5. DOI: 10.1212/wnl.52.8.1622. View

13.

Jauss M, Zanette E . Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography. Cerebrovasc Dis. 2000; 10(6):490-6. DOI: 10.1159/000016119. View

14.

Koppen H, Palm-Meinders I, Mess W, Keunen R, Terwindt G, Launer L . Systemic right-to-left shunts, ischemic brain lesions, and persistent migraine activity. Neurology. 2016; 86(18):1668-75. PMC: 4854588. DOI: 10.1212/WNL.0000000000002538. View

15.

Domitrz I, Mieszkowski J, Kaminska A . Relationship between migraine and patent foramen ovale: a study of 121 patients with migraine. Headache. 2007; 47(9):1311-8. DOI: 10.1111/j.1526-4610.2006.00724.x. View

16.

Wolfrum M, Froehlich G, Knapp G, Casaubon L, DiNicolantonio J, Lansky A . Stroke prevention by percutaneous closure of patent foramen ovale: a systematic review and meta-analysis. Heart. 2013; 100(5):389-95. DOI: 10.1136/heartjnl-2013-304394. View

17.

Rigatelli G, DellAvvocata F, Cardaioli P, Giordan M, Braggion G, Aggio S . Permanent right-to-left shunt is the key factor in managing patent foramen ovale. J Am Coll Cardiol. 2011; 58(21):2257-61. DOI: 10.1016/j.jacc.2011.06.064. View

18.

Wahl A, Kunz M, Moschovitis A, Nageh T, Schwerzmann M, Seiler C . Long-term results after fluoroscopy-guided closure of patent foramen ovale for secondary prevention of paradoxical embolism. Heart. 2007; 94(3):336-41. DOI: 10.1136/hrt.2007.118505. View

19.

Ruchalla E . [Migraine: Structural brain changes in MRI]. Rofo. 2014; 185(12):1130. DOI: 10.1055/s-0033-1346802. View

20.

Yang Y, Guo Z, Wu J, Jin H, Wang X, Xu J . Prevalence and extent of right-to-left shunt in migraine: a survey of 217 Chinese patients. Eur J Neurol. 2012; 19(10):1367-72. DOI: 10.1111/j.1468-1331.2012.03793.x. View