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

Xiao-Han Jiang,Pan Lin,Rong Guo,Qian Tian,Si-Bo Wang,Ying-Hua Cui,Ying-Qi Xing,Yong You,Ya-Jie Li,Guan-Ling Zhang,Chi Zhong

doi:10.1186/s12883-018-1022-7

Abstract

BackgroundMigraine 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.MethodsWe 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.ResultsWe 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.ConclusionOverall, 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 registrationNo. NCT02425696; registered on April 21, 2015.

Highlights

Migraine is considered as a risk factor for subclinical brain ischemic lesions, and right-to-left shunt (RLS) is more common among migraineurs
We evaluated whether, in migraineurs, (1) RLS per se, or a particular size/subtype of RLS, is associated with a higher incidence of silent brain infarctions (SBI) and white matter hyperintensities (WMHs); (2) RLS is associated with increased SBI located in the posterior circulation; (3) deep WMHs is more commonly present in subjects with RLS than those without RLS
Compared with the no-RLS group, SBI (8.9% vs. 5.5%, p = 0.265) and WMHs (54.5% vs. 49.1%, p = 0.355) did not increase with RLS in migraineurs (Table 1)

Summary

Introduction

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. The relationship between migraine and subclinical brain ischemic lesions, including silent brain infarctions (SBI) and white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI), is complicated and disputed [1,2,3,4,5]. Right-to-left shunt (RLS) may be a shared risk factor in migraine and subclinical brain ischemic lesions. RLS, and large RLS, caused mainly by a patent foramen ovale (PFO) [12], is considered to be a cause of cryptogenic stroke (CS) in young patients [13]

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Conclusion