Does The Right To Letf Shunt Increase The Incidence Of Brain Multiple Ischemic Lesions In Migraine Patients?

Background:Ischemic lesions are commonly found on brain MRI of migraine patients. Several studieshave documented the association between patent foramen ovale (PFO) and migraine. The aimof the study was to test whether the incidence of ischemic lesions in migraine patients withPFO was different from that of migraine patients without PFO on MR imaging.Method:From2010to2011,263patients with migraine were enrolled in the study. The patientsunderwent a standard headache and vascular risk factors questionnaire, Transcranial Doppler(TCD), TCD bubble test, and brain MRI. Migraine patients without right-to-left shunt wereconsidered as controls. The severity of the shunt was quantified as mild (<10microbubble),moderate (10-30microbubble) or severe (>30microbubble). Standard MRI was performed inall patients including T1WI, T2WI, T2-dark flair and DWI. The presence of ischemic lesionswas identified by2independent neuro-radiologists.Results:Out of the127migraine patients with RLS and136migraine patients without RLS,67migraine patients with RLS and54without RLS were found to have ischemic lesions on MRimaging. Ischemic lesions associated significantly with RLS in migraine patients (P<0.05,Chi-square).The incidence of ischemic lesions in migraine patients was39.6%,47.5%,54.4%,and58.7%in Non-RLS, Mild-RLS, Moderate-RLS, and Severe-RLS groups, respectively.Only severe RLS was found significantly associated with ischemic focus in MR imaging.Conclusion:The presence of RLS increases the risk of MRI detectable ischemic lesions in migrainepatients.