The Research Of The Relationships Between Right-to-letf Shunt And Nervous System Diseases

Objective: To assess the prevalence of right-to-left shunt (RLS) in headache patients,ischemic stroke patients and syncope patients in China and to evaluate the relationshipsbetween the extent of RLS and these diseases.Methods: A total of380consecutive headache patients,36cryptogenic stroke patientsand34syncope patients were recruited from the Department of Neurology from April2010to February2011. Contrast-enhanced transcranial Doppler was used to assess the prevalenceof RLS in all subjects and to evaluate the relationship between the extent of RLS and thesediseases. Other clinical workup consisted of a thorough physical examination, laboratorytests including liver and kidney function tests, hematology profiles, transcranial doppler andcarotid ultrasound.Results:1.①The total positive RLS rate in the headache group was similar to that inthe healthy group (36.1%vs28.0%, p>0.05), but the large RLS rate was also higher in theheadache group than in the healthy group (17.1%vs5.0%, p<0.05);②T he total positive andlarge RLS rates in the migraine group were significantly higher than those in the healthygroup (44.2%vs28.0%, p<0.05;23.5%vs5.0%, p<0.05) and non-migraine group (44.2%vs25.2%, p<0.05;23.5%vs8.6%, p<0.05);③The total positive and large RLS rates in themigraine with aura group were significantly higher than those in the healthy group (66.1%vs28.0%, p<0.05;37.3%vs5.0%, p<0.05) and migraine without aura group (66.1%vs36.1%,p<0.05;37.3%vs18.4%, p<0.05);④T he total positive RLS rate in the migraine withoutaura group was similar to that in the healthy group (36.1%vs28.0%, p>0.05), but the largeRLS rate was also higher in the MwoA group than in the healthy group (18.4%vs5.0%,p<0.05). The small RLS rates were similar in all groups.2. The total positive and large RLS rates in the cryptogenic stroke group weresignificantly higher than those in the healthy group (61.1%vs30.0%, p<0.05;38.9%vs5.0%, p<0.05) and stroke group (61.1%vs26.7%, p<0.05;38.9%vs0.0%, p<0.05).3. The total positive RLS rate in the syncope group was similar to that in the healthygroup (32.4%vs30.0%, p>0.05), but the large RLS rate was also higher in the syncopegroup than in the healthy group (26.5%vs5.0%, p<0.05). Conclusions: Close correlations have been documented between RLS and migraine,cryptogenic stroke and syncope, but these relationships exist only when the shunts werelarge.