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© 2008 American Academy of Neurology Right-to-left shunt does not increase white matter lesion load in migraine with aura patientsFrom the Stroke Center (A.A., G.R.), Department of Neurology, Sacro Cuore Hospital, Negrar, Verona, Italy; Department of Radiology (R.C., R.P.M.), University of Verona, Italy; Vesalius Research Centre (V.N.T.), Flanders Interuniversity Institute for Biotechology, Leuven, Belgium; Service of Neurology (G.P.A.), S. Orsola Hospital FBF, Brescia, Italy; Department of Neurosciences (M.D.S., C.F.), University of Genova, Italy; Department of Neurosciences (G.M.), University of Padova, Italy; and Department of Neurosciences (C.Z.), University of Parma, Italy. Address correspondence and reprint requests to Dr. A. Adami, Stroke Center, Neurology Department, Ospedale Sacro Cuore, via Sempreboni 6, 37024 Negrar-Verona, Italy alessandro.adami{at}sacrocuore.it Background: White matter lesions (WMLs) are commonly found on brain MRI of migraine patients. Migraine with aura (MA+) is associated with an increased frequency of right-to-left shunt (RLS) mostly due to patent foramen ovale. The relationship between WML load and RLS in MA+ is currently unknown.
Methods: MA+ patients were consecutively enrolled as part of the Shunt Associated Migraine (SAM) study. Patients underwent a standardized headache and vascular risk factors questionnaire, contrast-enhanced transcranial Doppler, blood coagulation tests, and brain MRI. RLS was categorized into four grades: no shunt, <10 microbubbles (mb), >10 mb single spikes pattern, and >10 mb shower/curtain pattern. Standard and fluid-attenuated inversion recovery T2-weighted MRI sequences were inspected for WMLs by three independent raters blinded to RLS grade. WML load was scored in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Scheltens scale. Interobserver agreement was good to excellent ( Results: One hundred eighty-five patients (77% women) were included. PV-WML load was similar between patients with and without RLS. D-WML load decreased in patients with RLS (p = 0.045). On logistic regression analysis, only age was associated with WMLs (p < 0.001). Conclusions: The presence of right-to-left shunt does not increase white matter lesion load in patients who have migraine with aura.
Abbreviations: ce-TCD = contrast-enhanced transcranial Doppler; D-WMLs = deep white matter lesions; FLAIR = fluid-attenuated inversion recovery; MA+ = migraine with aura; mb = microbubbles; MTHFR = methyl-tetra-hydro-folate-reductase; OR = odds ratio; PFO = patent foramen ovale; PV-WMLs = periventricular white matter lesions; RLS = right-to-left shunt; SAM = Shunt Associated Migraine; TTE = transthoracic echocardiography; WMLs = white matter lesions.
*Shunt Associated Migraine (SAM) investigators are listed in the appendix. The SAM study was partially funded by a grant from Associazione Fatebenefratelli per la Ricerca. V.N.T. is supported by the Fonds voor Wetenschappelijk Onderzoek Vlaanderen. Disclosure: The authors report no disclosures. Presented in shortened version as an oral presentation at the 32nd International Stroke Conference, February 7–9, 2007, San Francisco, CA, and as a poster at the 59th Annual Meeting of the American Academy of Neurology, April 28–May 5, 2007, Boston, MA. Received November 7, 2007. Accepted in final form March 17, 2008. This article has been cited by other articles:
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= 0.64 to 0.96, p < 0.0001). WML load was then correlated between patients with and without RLS. 
