Page 66 - Migraine, the heart and the brain

Chapter 3
Table 3 Prevalence of ongoing recurrence of migraine attacks by presence and subtype of right-to-left shunt
Migraine (all)
Migraine with aura
Migraine without aura
Spontaneous RLS Ongoing recurrence
Total RLS
Ongoing recurrence
With RLS n = 46
35 (76)
N = 86
57 (66)
Without RLS n = 120
66 (55)a
N = 80
44 (55)
With RLS n = 34
29 (85)
N = 58 44 (76)
Without RLS n = 62
39 (63)a
N = 38
24 (63)
With RLS n = 12
6 (50)
N = 28
13 (46)
Without RLS n = 58
27 (47)
N = 42
20 (48)
Abbreviation: RLS=right-to-left shunts.
Data are expressed as n (%). Unless indicated otherwise, differences were not signi cant (p>0.05). a p<0.05.
Table 4 and table e-1 also on the Neurology® Web site at Neurology.org summarize the prevalence of MRI detectable brain lesions by RLS type in the 229/235 (97%) participants who underwent TCD-c and for whom MRI data were available. Prevalence of silent infarcts in the posterior cerebral circulation in participants with RLS (9%) was not different from those without RLS (3%; OR 2.8; 95% CI 0.9–9.3; p= 0.08). This was irrespective of migraine status (data not shown).
The risk of posterior circulation silent infarcts was further assessed using a multivariate regression model (with migraine presence, RLS presence, and age as covariates). Higher age (p=0.004) and possibly RLS (p=0.08), but not migraine (p=0.7), were associated with an increased infarct risk. No signi cant associations were found between RLS (subtypes) and deep white matter lesions, also not when strati ed for sex.
Table 4 Prevalence of MRI ndings by subtype of right-to-left shunt
Spontaneous RLS
aTotal RLS
b p Value
0.3 0.1 0.08
0.6 4
Any silent brain infarct
Multiple silent brain infarcts
Silent brain infarct posterior Circulation
Infratentorial hyperintensities
High volume deep white matter lesions
No RLS (n = 167) 23 (14)
9 (5) 10 (6)
23 (14) 31 (19)
RLS (n = 62) 7 (11)
2 (3) 4 (7)
13 (21) 13 (21)
p Value 0.6
0.5 0.9
0.2 0.7
No RLS (n = 118) 13 (11)
3 (3) 4 (3)
20 (17) 20 (17)
RLS (n = 111) 17 (15)
8 (7) 10 (9)
16 (14) 24 (22)
Abbreviation: RLS=right-to left shunts
Any brain infarct indicates a brain infarct in any vascular territory. Multiplebrain infarct-like lesions indicates more than one infarct-like lesion in any vascular territory. High volumedeep white matter lesions de nedas upper 20th percentile. Data are expressed as n (%).
ap Value: no spontaneous RLS vs spontaneous RLS.
bp Value: no RLS vs RLS.
64