Application Of C-TCD In Migraine And Cryptogenic Stroke And Correlation Analysis

Objective: One of the reasons for migraine and cryptogenic stroke in recent years is a growing number of reports of right-to-left shunt(RLS).The main purpose of this experiment is to study the application of contrast-enhanced transcranial Doppler(c-TCD)in screening the causes of migraine and cryptogenic stroke and to analyze the clinical characteristics of c-TCD positive patients.To help clinicians in the prevention,treatment and prognosis of the disease.Methods: From November 2017 to December 2018,48 patients with migraine were diagnosed in the Department of Neurology,affiliated Hospital of Inner Mongolia Medical University,and 62 patients with cryptogenic stroke were included in this experiment.All patients underwent contrast-enhanced transcranial Doppler(c-TCD),right angiocardiography(c-TTE)and transesophageal echocardiography(TEE),)to monitor and quantify the number of microbubbles or emboli in real time.Using the results of TEE as the diagnostic criteria,the detection rates of c-TCD and c-TTE were compared and compared with those of TEE.At the same time,general data of patients,smoking,drinking,hypertension,diabetes mellitus,blood biochemical indexes such as blood lipid,homocysteine and other common risk factors and surgical situation were recorded in the group,and the relevant data were analyzed.Results:1.Migraine group: in 48 migraine patients,16 cases were c-TCD positive,13 cases were c-TTE positive,16 cases of TEE with patent foramen ovale(PFO),and the other 32 cases with negative c-TCD were also negative for c-TTE and TEE confirmed that there was no one with patent foramen ovale.The detection rate of c-TTE was significantly lower than that of TEE(P < 0.01).The results of c-TCD were the same as those of TEE.The detection rate of c-TTE(29.17%)and sensitivity(87.5%)were lower than those of c-TCD(33.33%)and sensitivity(100%).There was no significant difference in the proportion of smokers,alcoholics,hypertension,diabetes mellitus,hyperlipidemia and hyperhomocysteine between RLS positive group and RLS negative group(P > 0 05).However,the proportion of malemigraine patients with premonitory migraine was significantly different between the positive group and the negative group(P < 0.05).Of the 16 patients with positive migraine,5 were occluded.All the patients were followed up and the headache was relieved.C-TCD and c-TTE were performed 2 days and 3 months after the operation,and the results were negative in all 4 patients.The headache was relieved in one patient 2 days after operation,and a small number of microemboli were found after Valsalva movement during c-TCD.After 3 months,the headache of the patient was more severe than that before.The middle dose of microemboli was detected after Valsalva by c-TCD.2.Cryptogenic stroke group: in 62 patients with cryptogenic stroke,there were 16 patients with c-TCD positive,13 patients with c-TTE positive,and TEE confirmed that 16 patients with PFO.The other 46 patients were negative with c-TCD and c-TTE,and no PFO was found after TEE examination.The results of TEE were determined as diagnostic criteria.The results of c-TCD were consistent with those of TEE.The detection rate of c-TTE was lower than that of TEE(P < 0.01).The detection rate of c-TTE(22.58%)and sensitivity(87.5%)were lower than those of c-TCD(25.80%)and(100%).The risk factors of smoking,alcoholism,hypertension,diabetes mellitus,hyperlipidemia and hyperhomocysteinemia were significantly different between RLS positive group and RLS negative group(P < 0 05).The proportion of the above risk factors in the negative group was significantly higher than that in the positive group.But there was no significant difference in sex ratio between positive group and negative group(P > 0.05).16 patients with cryptogenic stroke were occluded by operation in 6 patients.C-TCD and c-TTE were performed on 2 days and 3 months after operation respectively.The results of both tests were negative.Conclusions: 1.c-TCD can evaluate the right to left shunt,and it is more sensitive to the smaller shunt,which can be used for the reexamination and evaluation of the patients after occlusion.2.In clinical patients with suspected PFO,we can first do c-TCD screening,clear PFO,and then TEE to determine the anatomical relationship and PFO gap size.Moreover,c-TCD has the advantages of bedside operation,high sensitivity,safety,non-invasive and easy to repeat operation,and can be popularized as a screening method of PFO in the region,which can not only be economical but also reduce the pain of patients.Easy to be accepted by patients.3.The proportion of smoking,drinking,hypertension,hyperlipidemia,diabetes and hyperhomocysteine in patients with right-to-left shunt positive cryptogenic stroke was lower than that in patients with negative foramen ovale.To some extent,this confirms that the cause of cryptic stroke is more likely to be shunt from right to left.4.Migraine with right-to-left shunt is more likely to occur in male patients,and the positive rate of right-to-left shunt in aura migraine is higher than that in non-aura migraine.Therefore,male patients who encounter threatened migraine in clinic can first consider whether they have right-to-left shunt.5.Occlusive treatment can be considered in patients with migraine and cryptogenic stroke with RLS.