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

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

Abstract

Background: 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.

Methods: We 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.

Results: We 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.

Conclusion: Overall, 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 registration: No. NCT02425696 ; registered on April 21, 2015.

Keywords: Infarction; Magnetic resonance imaging; Migraine; Patent foramen ovale; Transcranial Doppler ultrasonography; White matter.

Conflict of interest statement

Ethics approval and consent to participate

The study procedures were approved by the Ethics Committee of the First Hospital of Jilin University. The number of approval letter was 2015–180. All patients provided written informed consent prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The four-level RLS categorization based on the microbubbles count. a Grade 0 = Negative; b Grade I = 1 ≤ MBs ≤ 10; c Grade II = MBs > 10 and no curtain; d Grade III = curtain. Abbreviations: RLS (right-to-left shunt); MBs (microbubbles)
Fig. 2
Fig. 2
a A subclinical brain infarction in anterior circulation. b The white matter hyperintensity in deep white matter
Fig. 3
Fig. 3
Flow chart of patient enrolment

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