Brainstem and cerebellar hyperintense lesions in migraine

Department of Radiology, Leiden University Medical Center, PO Box 9600, The Netherlands.
Stroke (Impact Factor: 5.72). 05/2006; 37(4):1109-12. DOI: 10.1161/01.STR.0000206446.26702.e9
Source: PubMed


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
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    • "According to previous data [63], they found an increased prevalence of periventricular and subcortical white matter lesions (PVWMLs and DWMLs, respectively), but not of cerebellar infarcts, unlike their earlier study. In the majority of cases (86%), the lesions were located in the pons (pontine hyperintense lesions [PHLs]) [64]. The recent Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis (CAMERA) study, which randomly selected 295 patients with migraine and 140 controls from a previously diagnosed population-based sample (n = 6039), showed a higher prevalence of subclinical infarcts in the posterior circulation, most pronounced for patients who were migraineurs with aura [OR 13.7; 95% CI 1.7, 112], and of brainstem hyperintense lesions (4.4% vs. 0.7%, P = 0.04). "
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    • "The association of migraine and white matter lesions is also significantly increased among female patients with migraine (Odds ratio [OR] 2.0; 95% CI: 1.0–4.2).[1112] The frequency of migraine attacks (greater than one per month) further increases the risk of developing focal hyperintense lesions on MRI scan (O 2.6; 95% CI: 1.2–6.00).[1114] More recently, both the migraine disease duration (14 vs. 20 years, P=0.004) and the migraine frequency (4 vs. 6 attacks per month, P=0.017) have been found to significantly affect the load of hyperintense lesions on MRI.[15] "
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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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