Sztajzel R, Genoud D, Roth S, Mermillod B, Le Floch-Rohr J
Department of Neurology, Neurosonology Unit, Geneva, Switzerland.
Cerebrovasc Dis. 2002;13(2):102-6. doi: 10.1159/000047758.
Recent studies reported an increased prevalence of patent foramen ovale (PFO) in patients with migraine with aura (MA+). To investigate the possible relationship between MA+ and paradoxical embolism, we studied the prevalence of both conditions. Investigation of PFO was undertaken in 74 consecutive patients presenting with an acute stroke of undetermined origin. The patients were questioned about MA+ or migraine without aura (MA-) according to the criteria of the International Headache Society. Follow-up was performed to investigate the evolution of MA+ and MA- according to different treatments of stroke. PFO was found in 44 of 74 patients, 16 of whom had MA+ (36%), compared to 4 (13%) MA+ patients without PFO (p = 0.03). Of 25 patients in whom the PFO was considered to play a causal role in the stroke, 13 (52%) had MA+, whereas only 3 (16%) of 19 patients in whom PFO was considered unrelated had MA+ (p = 0.014). Thirty-nine of the patients with MA+ and MA- were studied over a mean follow-up of 13 months. Seven of 15 patients with MA+ and PFO, treated either with surgical closure or anticoagulants, noticed complete disappearance of MA+ attacks. The prevalence of MA+ is high among stroke patients with PFO. In patients with a high presumption of paradoxical embolism, the proportion of MA+ is increased, and this suggests a possible role of this association in the occurrence of the cerebrovascular event. Forty-seven percent of patients with PFO and MA+ reported complete suppression of their aura attacks after surgical closure or anticoagulant treatment. This finding suggests that at least in some patients, MA+ attacks may be due to paradoxical embolism.
近期研究报告称，有先兆偏头痛（MA+）患者的卵圆孔未闭（PFO）患病率有所增加。为了研究MA+与反常栓塞之间的可能关系，我们对这两种情况的患病率进行了研究。对74例连续出现不明原因急性卒中的患者进行了PFO调查。根据国际头痛协会的标准，询问患者是否有MA+或无先兆偏头痛（MA-）。进行随访以调查根据不同的卒中治疗方法MA+和MA-的演变情况。74例患者中有44例发现有PFO，其中16例有MA+（36%），相比之下，无PFO的MA+患者有4例（13%）（p = 0.03）。在25例被认为PFO在卒中中起因果作用的患者中，13例（52%）有MA+，而在19例被认为PFO无关的患者中只有3例（16%）有MA+（p = 0.014）。对39例有MA+和MA-的患者进行了平均13个月的随访。15例有MA+和PFO的患者中，7例接受了手术封堵或抗凝治疗，他们注意到MA+发作完全消失。PFO的卒中患者中MA+的患病率很高。在高度怀疑有反常栓塞的患者中，MA+的比例增加，这表明这种关联在脑血管事件的发生中可能起作用。47%有PFO和MA+的患者报告在手术封堵或抗凝治疗后先兆发作完全得到控制。这一发现表明，至少在一些患者中，MA+发作可能是由于反常栓塞所致。
