Brain stem and cerebellar hyperintense lesions in migraine. Stroke

Department of Radiology, Leiden University Medical Center, PO Box 9600, The Netherlands.
Stroke (Impact Factor: 6.02). 05/2006; 37(4):1109-12. DOI: 10.1161/01.STR.0000206446.26702.e9
Source: PubMed

ABSTRACT Migraineurs are at increased risk of cerebellar infarcts and supratentorial white matter lesions. The prevalence, frequency, and distribution of infratentorial hyperintense lesions in migraine are unknown.
Migraineurs with aura (n=161), without aura (n=134), and controls (n=140) from a population-based sample of adults (30 to 60 years of age) were evaluated with MRI.
Infratentorial hyperintensities were identified in 13 of 295 (4.4%) migraineurs and in 1 of 140 (0.7%) controls (P=0.04). Twelve cases had hyperintensities, mostly bilaterally, in the dorsal basis pontis. Those with infratentorial hyperintensities also had supratentorial white matter lesions more often.
We found an increased prevalence of infratentorial (mostly pontine) hyperintensities in migraineurs from the general population. This extends the knowledge about vulnerable brain regions and type of lesions in migraine brains. A hemodynamic ischemic pathogenesis is likely, but further research is needed.

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Available from: Mark A van Buchem, Aug 26, 2015
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    • "In basilar-type migraine, patients exhibit typical brainstem symptoms in the aura phase (Kirchmann et al, 2006). Furthermore, 'hyperintensities' in the brainstem of migraineurs were seen in magnetic resonance imaging investigations more often than in healthy control subjects (Kruit et al, 2006). The neurologic basis for such activations is unclear yet, but depolarizations as shown in this study might be a possible candidate. "
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    ABSTRACT: The brainstem of the adult rat is relatively resistant to spreading depolarization (SD) but after enhancement of excitability SD can be evoked by local application of KCl. In the present experiments, we observed that the enhanced excitability even triggers prolonged periods of repetitive depolarizations (RDs), which elicit significant cardiovascular changes. In contrast to KCl-evoked SDs with amplitudes of ∼24 mV and spreading velocity of 4 mm/min, spontaneous RDs had amplitudes of 7 to 12 mV, propagated up to 30 times faster than KCl-evoked SDs, and depolarized larger brainstem areas including the contralateral side. Similarly as SD, RDs depended on glutamatergic neurotransmission and were blocked by MK-801 or by the calcium channel blocker agatoxin. They depended on sodium channels and were blocked by tetrodotoxin. Functionally, the invasion of RDs into the spinal trigeminal and other nuclei evoked bursts of action potentials, indicating that specific neuronal systems are affected. In fact, during episodes of RDs the blood pressure and the local blood flow at the surface of the brainstem and the cortex increased substantially. Brainstem RDs did not propagate into the cerebral cortex. We propose to consider brainstem RPs as a pathophysiological mechanism whose significance for brainstem disease states should be further explored.
    Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism 03/2012; 32(8):1535-45. DOI:10.1038/jcbfm.2012.40 · 5.34 Impact Factor
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    • "During this migraine subtype, patients show typical brainstem symptoms in the aura phase (Kirchmann et al, 2006). Furthermore, in magnetic resonance imaging investigations, migraineurs exhibit more 'hyperintensities' in the brainstem than healthy control subjects (Kruit et al, 2006). It may be speculated that these changes are caused by ischemic processes SD in the adult rat brainstem F Richter et al in the brainstem, and that brainstem SDs are involved in the generation of such changes. "
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    ABSTRACT: Cortical spreading depression is a pathophysiological excitation wave that occurs during pathophysiological brain conditions such as ischemic brain infarction, migraine aura, and others. Judged from experiments in rodents, the brainstem is thought to be comparatively resistant to the generation of spreading depression. However, because spreading depression can be elicited in the brainstem of rat pups after superfusing the brainstem with solutions enhancing excitability, we reinvestigated spreading depression in the brainstem of the adult rat. Based on theoretical predictions indicating a major role of extracellular potassium in susceptibility to spreading depression, we used conditioning solutions in which chloride ions were replaced by acetate and tetraethylammonium chloride and a small amount of KCl were added. Under these conditions, spreading depression was reproducibly elicited in the brainstem either by topical application of KCl crystals to the brainstem surface or by local microinjection of KCl into the brainstem. The direct current shifts so elicited were accompanied by typical elevation of extracellular potassium ions, propagated in the brainstem, and were prevented by MK-801, an N-methyl D-aspartate blocker. During spreading depression, the regional blood flow in the brainstem was transiently increased. In addition, systemic arterial blood pressure, but not the heart rate, was transiently enhanced. In the nonconditioned brainstem, KCl stimulation neither elicited spreading depression nor induced changes in regional blood flow and blood pressure. These data show that proper conditioning renders the brainstem susceptible to spreading depression, and that spreading depression at this site elicits changes in local circulation and systemic blood pressure.
    Journal of Cerebral Blood Flow & Metabolism 06/2008; 28(5):984-94. DOI:10.1038/sj.jcbfm.9600594 · 5.34 Impact Factor
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    • "Whether these findings are clinically relevant, needs to be explored. A tentative correlation , for instance, could be made with previous findings of in previous studies our group has shown our group demonstrating increased prevalence of pontine hyperintensities and cerebellar infarcts in migraineurs from the general population (Kruit et al., 2004, 2006). "
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    Brain 05/2008; DOI:10.1093/brain/awn260 · 10.23 Impact Factor
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