偏头痛右向左分流患者与脑白质病变的关系研究

目的 探讨偏头痛右向左分流患者与脑白质病变之间的关系。方法 自2014年7月至2017年2月就诊于北京天坛医院门诊,诊断符合国际头痛诊断分类的偏头痛患者。收集基线信息及临床特征等相关资料。所有入组患者均进行经颅多普勒发泡试验及头颅磁共振检查。右向左分流定义为：经颅多普勒发泡试验提示双侧大脑中动脉监测到至少一个及以上栓子信号。脑白质病变的评定为：深部或皮质下白质T2加权像及FLAIR成像高信号。脑白质病变使用Fazekas量表评分。结果 最终纳入254个患者（57.1%为女性）。143例受试者存在右向左分流（56.3%）。149例患者存在脑白质病（58.7%）。与脑白质病变阴性组（n=105）相比,右向左分流在脑白质病变阳性组（n=149）明显增高（69.1% vs 38.1%,P<0.05）。结论 偏头痛患者脑白质病变可能与右向左分流相关。     

偏头痛患者脑白质高信号与右向左分流相关性的福建地区单中心研究

目的观察偏头痛患者脑白质高信号(white matter hyperintensities,WMHs)的发生率和右向左分流(right-to-left shunt,RLS)的阳性率分布情况,探讨偏头痛患者WMHs与RLS是否相关。方法入选确诊为偏头痛的106例患者为研究对象,收集基本资料和头痛的临床信息,行头颅MRI检查评估WMHs,通过经颅多普勒超声(transcranial doppler,TCD)发泡试验进行RLS的诊断和分级,分析WMHs和RLS两者的相关性。结果 106例偏头痛患者中,"WMHs+"组33例(31.1%),"WMHs-"组73例(68.9%)。RLS总阳性率为48.1%(51/106),各分流级别分布情况为:Ⅰ级分流27例(25.5%),Ⅱ级分流4例(3.8%),Ⅲ级分流6例(5.6%),Ⅳ级分流14例(13.2%)。"WMHs+"组中,Ⅰ级分流5例,Ⅱ级分流1例,Ⅲ级分流3例,Ⅳ级分流10例;"WMHs-"组中,Ⅰ级分流22例,Ⅱ级分流3例,Ⅲ级分流3例,Ⅳ级分流4例。"WMHs+"组和"WMHs-"组相比较,两组发泡试验总体阳性率没有统计学差异(P 0.05,χ~2=1.719),但"WMHs+"组的大量分流率显著高于"WMHs-"组,具有统计学意义(P 0.01,χ~2=13.188)。结论偏头痛患者的WMHs与RLS无明显相关,但大量分流的RLS会增加偏头痛患者WMHs发生的风险。     

房间隔缺损封堵术后新发偏头痛及偏头痛加重的临床分析

目的分析房间隔缺损封堵术后新发偏头痛及偏头痛加重患者的临床及相关检查特征。方法收集2011年9月~2014年5月间,房间隔缺损封堵术后新发偏头痛或已往偏头痛加重的患者,收集其临床资料,记录患者病史、体格检查结果。行经颅多普勒发泡试验、增强超声心动、影像学等检查,分析其临床及相关检查特征。结果共收集房间隔缺损封堵术后新发或原有症状加重的偏头痛患者4例。2例患者术后2 d内新发有先兆偏头痛。1例患者由术前无先兆偏头痛转为有先兆偏头痛。1例术前已诊断为有先兆偏头痛患者术后发作频率明显增加。4例患者术后行经颅多普勒发泡试验平静呼吸均未见右向左分流,Valsalva动作时3例均可见右向左分流,其中1例增强超声心动图可见右向左分流。3例患者行栓子监测均未见微栓子信号。4例患者影像学检查均未见异常。结论新发偏头痛或偏头痛加重可能是房间隔缺损封堵术的并发症,其原因可能与微栓塞关系不大。     

隐源性脑卒中患者右向左分流的发生率及分流量临床分析

目的应用经颅多普勒发泡试验(cTCD)分析隐源性脑卒中患者右向左分流发生率及分流量。方法明确诊断为隐源性脑卒中患者123例为实验组,分析右向左分流发生率及分流量。同时选取年龄相似健康体检者98例为对照组,隐源性脑卒中患者及健康体检者均行cTCD检查。结果 cTCD发泡试验阳性组56例(45.53%),阴性组67例(54.47%),其中大量分流42例(34.15%),小量分流14例(11.38%),大量分流及小量分流差别有统计学意义(P0.05)。结论卵圆孔未闭是隐源性脑卒中的独立危险因素,且右向左大量分流更易导致脑卒中。     

对比增强经颅多普勒评价偏头痛与心脏右向左分流关系的研究

目的观察中国偏头痛患者右向左分流(right-to-left shunt,RLS)的阳性率、分流类型以及分流量大小,分析偏头痛与RLS分流量的相关性。方法本研究共纳入204例偏头痛患者及122例健康志愿者,应用对比增强经颅多普勒造影(contrast-enhanced transcranial Doppler,c-TCD)诊断RLS并对阳性率、分流量进行统计分析。结果先兆偏头痛组RLS阳性率和大分流显著高于无先兆偏头痛组(65. 5%vs 32. 2%,P <0. 001; 32. 8%vs11. 6%,P <0. 001),而中量及小量分流无差异(P=0. 767; P=0. 095);先兆偏头痛组RLS阳性率和大分流均显著高于正常组(65. 5%vs 20. 5%,P <0. 001; 32. 8%vs 4. 1%,P <0. 001);无先兆偏头痛组RLS阳性率和大分流显著高于正常组(32. 2%vs 20. 5%,P=0. 038; 11. 6%vs 4. 1%,P=0. 027)。结论偏头痛患者(包括有先兆和无先兆偏头痛患者),右向左分流阳性率高于正常照组,且以大量右向左分流为主,中至小量右向左分流及分流的类型与正常组相比无差异。提示右向左分流,特别是大量的右向左分流,可能与偏头痛有关。     

TCD发泡试验对西宁地区无先兆性偏头痛与右向左分流的相关性研究

目的 探究经颅多普勒(TCD)发泡试验对地处中高海拔的西宁地区无先兆性偏头痛患者右向左分流(RLS)发生率的检测作用.方法 选取2018年11月至2020年7月西宁市第一人民医院收治的偏头痛患者273例(观察组),同期健康体检者200例(对照组),均进行TCD发泡试验,观察RLS的发生率.结果 观察组RLS阳性107例...     

伴右向左分流的隐源性缺血性卒中的临床和影像学特征

目的分析右向左分流相关隐源性缺血性卒中患者的临床特点及梗死灶影像特征。方法纳入隐源性缺血性卒中患者52例,根据经颅多普勒发泡试验结果分为伴右向左分流组(25例)及不伴右向左分流组(27例)。比较两组人群在人口学资料、脑血管病传统危险因素、梗死灶影像学等方面的差异。结果两组患者的年龄、性别比差异无统计学意义。伴右向左分流组患者无明确脑血管病传统危险因素的比例明显高于不伴右向左分流组(44%vs.14.8%,P=0.015),且其发生后循环梗死也更多见(56%vs.14.8%,P0.01),但两组患者的梗死灶大小无统计学差异(P0.05)。结论无明确脑血管病传统危险因素的后循环梗死患者,应注意排查是否存在右向左分流,以进一步明确卒中病因。     

对比增强经颅多普勒对隐源性缺血性卒中和先兆性偏头痛患者与右向左分流不同分流量相关性的研究

目的 对隐源性缺血性卒中和先兆性偏头痛患者的右向左分流阳性率及分流量进行对比分析,研究二者之间右向左分流的特征及可能的发病机制.方法 连续入组48例隐源性缺血性卒中患者、42例先兆性偏头痛患者、33例健康志愿者做为对照组,使用对比增强经颅多普勒诊断右向左分流,并根据分流量进行分级,对3组的右向左分流阳性率和不同分级进行...     

对比增强经颅多普勒超声对偏头痛与右向左分流相关性的福建地区单中心研究

目的观察偏头痛患者右向左分流(right-to-left shunt,RLS)的发生率,分析偏头痛与右向左分流的相关性。方法入选116例确诊为偏头痛的患者为病例组,75例健康志愿者为对照组,应用对比增强经颅多普勒超声(contrast-enhanced transcranial Doppler,c-TCD)诊断RLS并对分流量进行分级,分析两组的阳性率,进行统计分析。结果病例组中,RLS的阳性率为50.9%(59/116),其中,Ⅰ级分流35例(30.2%),Ⅱ级分流3例(2.6%),Ⅲ级分流7例(6.0%),Ⅳ级分流14例(12.1%)。对照组中,RLS的阳性率为30.6%(23/75),其中,Ⅰ级分流18例(24.0%),Ⅱ级分流1例(1.3%),Ⅲ级分流0例(0%),Ⅳ级分流4例(5.3%)。两组RLS总阳性率的比较,病例组的RLS总阳性率高于对照组,统计学有显著差异(P=0.006,χ~2=7.583);病例组的大量分流率显著高于对照组(P=0.011,χ~2=6.530),但两组的小量分流率比较无统计学差异(P=0.273,χ~2=1.199)。结论偏头痛与右向左分流存在相关,大量分流可能是偏头痛的病因,应引起临床重点关注。     

偏头痛脑白质病变的相关因素

目的 分析偏头痛脑白质病变(WML)的相关因素.方法 收集135例偏头痛患者(偏头痛组)及118名健康对照者(正常对照组)的临床资料.对入组者进行头颅MRI检查,并采用Fazekas量表评分评价WML情况;采用TCD声学造影检查右向左分流(RLS)情况.结果 偏头痛组WML发生率及深部WML(DWML)发生率显著高于正...     

Small deep white matter lesions are associated with right-to-left shunts in migraineurs

The right-to-left shunts (RLS) and white matter lesions (WMLs) are frequently observed in migraineurs and in patients with ischemic stroke. Previous studies have reported that the burden of WMLs did not increase with the intracardiac right-to-left shunt (RLS) in migraineurs. However, some types of WMLs are known to be associated with RLS in patients with stroke and dementia. The aim of the study was to demonstrate the difference in the size and location of WMLs, according to the existence of RLS in patients with headache. From the prospective headache registry, a total of 425 subjects (age, 30.8 ± 5.1 years; 303 women; 242 migraineurs; 183 patients with tension-type headache (TTH)) were retrospectively reviewed and evaluated for RLS and WMLs using M-mode power transcranial Doppler sonography (mTCD) and brain magnetic resonance imaging scans. We scored WMLs, according to the Rotterdam Scan Study, and assessed the association between RLS presence and the location and size of WMLs. The number of small deep WMLs (dWMLs) and the prevalence of RLS, defined as microembolic signals (MES) ≥11, were higher in patients with migraine (small dWMLs, 6.23 vs. 4.05; RLS, 36.8% vs. 10.9%), compared to patients with TTH. There was no significant difference in the sum of periventricular WML grades or the total volume of dWMLs between TTH and migraine patients. Among the migraineurs, the patients with RLS more frequently had small dWMLs, aura, and heart disease compared to those without RLS. In addition, RLS were also independent predictors for the presence of small dWMLs from the multivariate binary regression analysis (p < 0.01; OR = 3.24; 95%CI 1.56–6.72). Small dWMLs are associated with RLS in young migraineurs. These results imply that paradoxical embolism may cause the small WMLs in some migraineurs.     

White Matter Lesions in Children and Adolescents With Migraine

BackgroundThe etiology and clinical importance of white matter lesions in migraine remain poorly understood. To understand these issues more fully, we reviewed the brain magnetic resonance imaging scans of pediatric patients and assessed the relationships between white matter lesions, migraine type, patent foramen ovale, and right-to-left shunting.MethodsThe magnetic resonance imaging scans of a cohort of children (n = 89) and adolescents, ages 6 to 18 years, who participated in a study of migraine and patent foramen ovale were reviewed. All children in the cohort had undergone saline contrast transthoracic echocardiography and transcranial Doppler studies.ResultsWhite matter lesions were detected in 15 of the 89 patients (17%). White matter lesions were small (<5 mm) in the majority (10/15; 66%). We observed no relationship between the presence of white matter lesions and (1) migraine type (six patients with white matter lesions among 35 with migraine with aura [17%] vs. nine with white matter lesions among 54 without aura [17%]; P = 1.0); (2) patent foramen ovale (five with white matter lesions among 35 with patent foramen ovale [14%] vs. 10 with white matter lesions among 54 without patent foramen ovale [19%]; P = 0.77); or (3) shunt size (two large shunts in 15 with white matter lesions [13%] vs. nine large shunts among 72 without white matter lesions [13%]; P = 1.0).ConclusionsThese results indicate that small white matter lesions are not infrequent in children and adolescents with migraine. However, no relationships between white matter lesions and migraine type, patent foramen ovale, or degree of right-to-left shunting were observed.     

White matter lesions in chronic migraine with medication overuse headache: a cross-sectional MRI study

Analgesic overuse often happens to migraine patients, especially chronic migraineurs, and migraine has been demonstrated to be associated with white matter lesions (WMLs). The aim of this study was to investigate the relationship between medication overuse headache (MOH) and WMLs in chronic migraine (CM) patients. Subjects were enrolled and divided into three groups: healthy controls, CM without MOH (CMwoMOH), and CM with MOH (CM-MOH). Most of the CM patients used non-steroidal anti-inflammatory drugs (NSAIDs) as acute headache medications. All the participants underwent magnetic resonance imaging scans and images were obtained for WML evaluation with semiquantitative scales. One hundred and forty-one participants were included, 45 of them for controls, 38 for CMwoMOH, and 58 for CM-MOH. In women, CMwoMOH patients had a higher prevalence of high WML load compared with controls and CM-MOH patients. In men, however, all the study groups showed no differences in the prevalence of high WML load. CMwoMOH women had increased risks of high deep white matter lesion (DWML) load compared with controls, while they had no risks of high periventricular white matter lesion (PVWML) load. CM-MOH women had no risks of high DWML load, but they had reduced risks of high PVWML load. The association of CM-MOH with high WML load in women was not changed when compared with CMwoMOH. Age was independently associated with high WML load among women. These data suggest that MOH caused by NSAIDs is not a risk factor for WMLs. Rather, NSAID overuse probably protects MOH patients from WMLs through anti-inflammatory effects.     

Cerebrovascular risk factors and MRI abnormalities in migraine

Case series have demonstrated an increased incidence of white matter lesions (WMLs) in patients with migraine. It is controversial whether the evidence of subclinical brain lesions relates to a higher risk of cerebrovascular disease. The objective of this study was to evaluate the association between magnetic resonance imaging (MRI) subclinical brain lesions and cerebrovascular risk factors (hyperhomocysteinaemia, MTHFR genotype, patent foramen ovale, hypertension, smoking and hypercholesterolaemia). From our database of 1201 patients followed at our Headache Clinic since September 2003 we analysed the MRI findings of 253 individuals. All MRI were blindly analysed by a second neuroradiologist (C.A.) and patients with WMLs (study group) were evaluated. In order to assess the association of WMLs with specific vascular risk factors, patients with WMLs were matched, according to age, sex and ICHD II diagnosis, with an equal number of individuals with normal MRI (control group). Headache was classified by the International Classification of Headache Disorders (ICHD 2004) criteria. We did not find any statistically significant difference between the two groups with regard to the presence of the cerebrovascular disease risk factors considered. Our results confirm that the WMLs are not related to the cerebrovascular disease risk factors.

     

High total cerebral blood flow is associated with a decrease of white matter lesions

Abstract Background Low cerebral blood flow (CBF) has been associated with the presence of white matter lesions (WMLs). However, the power of these studies was insufficient (n=20–35) to determine whether flow is associated with WMLs. Purpose The aim of this study was to investigate whether total cerebral blood flow (tCBF) is associated with the severity of white matter lesions (WMLs) in a large patient sample. Subjects and methods 228 patients with clinical symptoms of cardiovascular disease had MRI of the brain, consisting of a T2-w FLAIR and a 2D phase-contrast flow measurement of the internal carotid arteries and the basilar artery. WMLs were graded according to prevalence and size of deep and periventricular WMLs. To determine the relation between tCBF and WMLs we used linear and logistic regression analysis adjusted for age, gender, intima media thickness and hypertension. Results We observed an inverse association between the tCBF and the total number of WMLs adjusted for age, gender, intima media thickness and hypertension [B=–1, 0 WML 95% CI (–2.0 to 0.0, p=0.045) per 100 mL increase in tCBF]. The adjusted odds ratio for the presence of severe WMLs in patients with high tCBF (> 675 mL/min) was 0.5 (95 % CI 0.2–1.0) compared with patients with normal tCBF. Conclusion In this study we found that high tCBF is associated with a decrease in presence and severity of WMLs.for the SMART study group     

微栓子信号的发生率及其临床意义

目的探讨常规接受微栓子监测检查患者的微栓子信号发生率以及其相关临床特征。方法连续纳入自2016年7月至2018年12月接受常规30 min微栓子监测以及常规TCD检查中探及到微栓子信号的患者,收集基线信息。结果共5 886例患者进行了30 min微栓子监测检查,其中50例存在微栓子信号,阳性率0.85%。大脑中动脉微栓子信号的出现率最高,达84%。46%(23/50)微栓子来源于动脉,包括8例动脉粥样硬化性脑动脉或颈动脉狭窄、10例颅内动脉、4例烟雾病和1例ANCA相关性动脉炎; 30%(15/50)提示心脏来源的微栓子,包括1例心房颤动、4例人造瓣膜和10例卵圆孔未闭;其他原因微栓子来源占24%(12/50),包括8例从右到左分流和4例未知来源。微栓子阳性的患者脑白质病变及认知障碍发生率高,分别为72%及68%。结论微栓子信号较罕见,不同的疾病微栓子信号的临床意义及机制可能不一样。     

Right‐to‐left shunts as a cause of juxtacortical spots in patients with migraine

Backgrounds: Juxtacortical spots on fluid‐attenuated inversion recovery (FLAIR) images can be frequently detected in patients with migraine. However, the origins of the cerebral lesions (including juxtacortical spots on FLAIR images) found in the previous studies are not known. We sought to investigate the association between juxtacortical spots on FLAIR images and right‐to‐left shunt (RLS) in migraine patients. Methods: Juxtacortical spots on FLAIR images were arbitrarily defined as small areas of hyperintensities in the juxtacortex and cortico‐subcortical junction. The presence of RLS was examined by a transcranial Dopper (TCD) with the agitated saline test. The degree of RLS was categorized into four grades according to the number of microemboli: no shunt, <10 microbubbles (MB), >10 MB single spots pattern, and >10 MB shower/curtain pattern. We compared the results for migraine patients (n = 49) with those for healthy controls (n = 49). Results: Juxtacortical spots on FLAIR images occurred in 38/98 subjects; of them, 27/49 (55.1%) had migraines and 11/49 (22.2%) were healthy controls (P = 0.002). The independent factors associated with juxtacortical spots on FLAIR images were female, migraine patients, and RLS by multivariate analysis. In migraine patients, RLS was independently associated with juxtacortical spots on FLAIR images. Conclusion: Our results suggest that juxtacortical spots on FLAIR images were frequently found in migraine patients and might be associated with the presence of RLS in those patients. Further studies are needed to assess whether juxtacortical spots have clinical implications in patients with migraine.     

Brain MRI white matter lesions in migraine patients: is there a relationship with antiphospholipid antibodies and coagulation parameters?

Brain magnetic resonance imaging (MRI) studies in migraine patients have demonstrated lesions consisting of focal regions of increased signal intensity within the white matter. Antiphospholipid antibodies are known to have a role in many diseases including migraine. The aim of the present study was to ascertain the relationship between MRI-visualized cerebral focal hyperintense lesions and serum antiphospholipid antibody levels, as well as blood coagulation parameters in migraine patients. One hundred and two (77 females, 25 males, mean age 33.8 ± 11.1) consecutive migraine patients and a control group of 94 (70 females, 24 males, mean age 33.2 ± 10.8) healthy subjects were enrolled. All individuals underwent brain MRI. Complete blood examinations, autoantibodies, antiphospholipids antibodies including anticardiolipin and lupus anticoagulant (aCL, LAC), antithrombin III, Protein C and S serum levels were ascertained in the subjects who presented white matter lesions on MRI. Twenty-seven (26.4%) migraine patients and six (6.3%) healthy subjects in the control group showed focal regions of increased intensity signal within cerebral white matter (odds ratio 5.3, 95% CI: 1.98–16.36). In migraine patients with white matter lesions, antiphospholipid antibodies were not detected and serum levels of antithrombin III, and proteins C and S were normal. White matter lesions in migraine patients are fairly common. This finding is not associated with antiphospholipid antibodies or abnormal coagulation parameters. The significance of such lesions at present remains unclear.     

25例颈动脉内膜剥脱术临床分析及术中经颅多普勒超声监测体会

目的探讨颈动脉内膜剥脱术(CEA)对颈动脉狭窄患者的疗效及术中经颅多普勒超声(TCD)监测经验总结。方法回顾25例CEA手术患者的临床资料及术中TCD监测情况。结果患者平均年龄64±10岁,男性23例,女2例。其中,左侧颈动脉狭窄11例(44%),右侧13例(52%),双侧狭窄而右侧较重者1例(4%)。除3例术中发生探头移位而未记录完整(均使用转流)外,余22例均全程监测。可根据CEA术中TCD监测大脑中动脉(MCA)血流速度变化了解术侧颈动脉远端供血情况,以确定是否转流。同时全程监测微栓子情况;术后有1例(4%)患者出现轻度神经系统缺损症状;2例(8%)出现谵妄;余22例(88%)未出现新发神经精神症状。结论 CEA可有效解除颈动脉狭窄及颈动脉易损斑块、降低卒中风险,术中TCD监测可为手术安全提供一定保障。