Kruit MC, Launer LJ, Ferrari MD, van Buchem MAInfarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain 128:2068-77

Department of Radiology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands.
Brain (Impact Factor: 9.2). 10/2005; 128(Pt 9):2068-77. DOI: 10.1093/brain/awh542
Source: PubMed


In a previous study, migraine cases from the general population were found to be at significantly increased risk of silent infarct-like lesions in the posterior circulation (PC) territory of the brain, notably in the cerebellum. In this study we describe the clinical and neuroimaging characteristics of migraine cases with and without aura and controls with PC lesions. In total, 39 PC infarct-like lesions represented the majority (65%) of all 60 identified brain infarct-like lesions in the study sample (n = 435 subjects with and without migraine). Most lesions (n = 33) were located in the cerebellum, often multiple, and were round or oval-shaped, with a mean size of 7 mm. The majority (88%) of infratentorial infarct-like lesions had a vascular border zone location in the cerebellum. Prevalence of these border zone lesions differed between controls (0.7%), cases with migraine without aura (2.2%) and cases with migraine with aura (7.5%). Besides higher age, cardiovascular risk factors were not more prevalent in cases with migraine with PC lesions. Presence of these lesions was not associated with supratentorial brain changes, such as white matter lesions. The combination of vascular distribution, deep border zone location, shape, size and imaging characteristics on MRI makes it likely that the lesions have an infarct origin. Previous investigators attributed cases of similar 'very small' cerebellar infarcts in non-migraine patients to a number of different infarct mechanisms. The relevance and likelihood of the aetiological options are placed in the context of known migraine pathophysiology. In addition, the specific involvement of the cerebellum in migraine is discussed. The results suggest that a combination of (possibly migraine attack-related) hypoperfusion and embolism is the likeliest mechanism for PC infarction in migraine, and not atherosclerosis or small-vessel disease.

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    • "We previously found that RLS positively associated with migraine [8]. In addition, as shown in a case-controlled study, the prevalence of infarct lesions was significantly increased in patients with migraine [13], together with the fact that latent RLS associated independently with a vertebrobasilar lesion location [14], we proposed the hypothesis that RLS might increase the prevalence of silent lacunar infarcts in patients with migraine. Previously, it had been found that the provoked RLS was positively associated with ischemic stroke in posterior circulation with incompletely clear mechanism [14]. "
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    ABSTRACT: Right-to-left shunt (RLS) is associated with cryptogenic stroke and migraine. Herein we investigated the relationship between RLS and silent lacunar infarcts in patients with migraine. A total of 263 patients with migraine who met eligibility criteria were enrolled from January 2010 to December 2011, among which 127 subjects fell into RLS group. Baseline demographics were comparable between RLS and non-RLS groups (P > 0.05). The incidence of silent lacunar infarcts in RLS group was not significantly different from that of the non-RLS group (25.2% versus 21.3%, P > 0.05). Furthermore, we found that the incidence of silent lacunar infarcts in permanent and latent RLS subgroups was comparable with non-shunt RLS subgroup (28.6% versus 24% versus 21.3%, P > 0.05). Similarly, the incidence of silent lacunar infarcts in the non-RLS group, mild-shunt group, and large-shunt group was also comparable (21.3% versus 23.8% versus 29.3%, P > 0.05). In addition, RLS did not increase the incidence of silent lacunar infarcts in migraine patients with elder age (<50 years age group: 15.8% versus 17.9%; ≥50 years age group: 53.1% versus 37.5%, both P > 0.05). In conclusion, RLS does not increase the incidence of silent lacunar infarcts in patients with migraine. Further prospective studies are warranted to validate this finding.
    08/2015; 2015:749745. DOI:10.1155/2015/749745
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    • "The mechanisms that link migraine to ischemic vascular disease are unknown [3]. It seems that cerebral infarcts preferentially affect posterior circulation [4,5]. The presence of the circle of Willis anomalies may contribute to decrease of cerebral blood flow in response to cortical spreading depression [6]. "
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    ABSTRACT: Background The circle of Willis is an important source of collateral blood flow to maintain adequate cerebral perfusion, particularly in the posterior circulation. Some studies report a relationship between incomplete circle of Willis and migraine, whereas other studies show no difference between the prevalence of incomplete circle of Willis in migraineurs and controls. In the present study we compared the prevalence of incomplete circle of Willis in female migraine patients without aura to female healthy non-migraine controls. Using 3-Tesla magnetic resonance angiography we recorded three-dimensional time-of-flight angiograms in 85 female participants (48 migraine patients without aura [median age 28 years] and 37 healthy controls [median age 25 years]). The images were subsequently analysed blindly by a neuroradiologist to detect incomplete circle of Willis. Findings We found no difference between the prevalence of incomplete circle of Willis in patients, 20/47 (43%), and controls, 15/37 (41%), p = 0.252. Post hoc analysis showed a significant relationship between age and prevalence of incomplete circle of Willis, p = 0.003. Conclusion We found no relationship between migraine without aura and incomplete circle of Willis.
    The Journal of Headache and Pain 05/2014; 15(1):27. DOI:10.1186/1129-2377-15-27 · 2.80 Impact Factor
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    • "The territory of the posterior cerebral artery is preferentially affected [25]. In addition to clinical strokes, focal ischemic and hyperintensive, ischemic-like lesions have been found in the territory of the posterior cerebral circulation [22] [26] [27]. "
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    ABSTRACT: It seems that migraine patients might suffer from localized and not systemic endothelial dysfunction. However, the probability whether impaired endothelial function in the posterior cerebral circulation, and intact endothelial function elsewhere is associated with migraine is not known. This is a post hoc study based on two of our previous published studies that evaluated cerebral and systemic endothelial function in 40 migraine patients (20 with (MwA) and 20 without aura (MwoA)) without comorbidities, and 20 healthy subjects. Cerebrovascular reactivity (CVR) to l-arginine in the middle (MCA) and posterior (PCA) cerebral artery as well as flow mediated vasodilatation (FMD) were used for this purpose. The logistic regression analysis was used to evaluate the association between CVR to l-arginine, FMD and migraine. We found a significant association between CVR to l-arginine in the PCA and migraine (OR: 0.38; CI 95%: 0.19–0.79; p = 0.01), but not between CVR to l-arginine in the MCA and migraine (OR: 0.74; CI 95%: 0.34–1.59; p = 0.44). Similar results were obtained in MwA and MwoA. We did not find any significant association between FMD and migraine (OR: 0.99; CI 95%: 0.83–1.19; p = 0.96). The same conclusion was reached in both migraine groups (MwA OR: 1.0; CI 95%: 0.83–1.19; p = 0.99, MwoA OR: 0.99; CI 95%: 0.81–1.21; p = 0.99). We could conclude that impaired endothelial function in the posterior cerebral circulation is associated with migraine, both MwA and MwoA, while intact endothelial function in the anterior cerebral and systemic circulation is not associated only with migraine.
    Perspectives in Medicine 09/2012; 1(1-12):297-300. DOI:10.1016/j.permed.2012.02.036
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