Wilmshurst Peter, Nightingale Simon, Pearson Matthew, Morrison Lindsay, Walsh Kevin
Royal Shrewsbury Hospital, Shrewsbury, United Kingdom.
Am J Cardiol. 2006 Sep 15;98(6):831-3. doi: 10.1016/j.amjcard.2006.03.070. Epub 2006 Aug 2.
This study investigated whether the increased incidence of stroke in young subjects with migraine is because they have an increased prevalence of atrial right-to-left shunts. The investigators report the prevalence of clinically relevant atrial shunts in those with stroke and migraine compared with those with stroke but without migraine and also in historic control groups of subjects who had migraine with aura but no stroke and in population controls. Of 60 consecutive stroke patients, 42 (70%) had large- or medium-sized atrial shunts. Transcatheter shunt closure was performed in 39 patients, of whom 35 had patent foramen ovales (mean diameter 9.8 +/- 4.1 mm) and 4 had atrial septal defects. If atrial shunts were unrelated to stroke in patients with migraines, shunt prevalence in those with migraine and stroke would be the same as in those with migraine but without stroke. However, a much greater shunt prevalence was found in those with stroke and migraine with aura (84%) than in those with migraine with aura but no stroke (38.1%, p <0.001), population controls (12.2%, p <0.001), and those with stroke but no migraine (55.6%, p <0.05). Shunt prevalence was also significantly greater in patients who had stroke and migraine without aura (75%) than in population controls (p <0.001) and in those with migraine with aura but no stroke (p <0.05). In conclusion, the increased incidence of stroke in subjects with migraine compared with the general population is because they have a higher prevalence of large atrial shunts and hence an increased risk for paradoxic embolism.
本研究调查了偏头痛年轻患者中风发病率增加是否是因为他们存在从右心房向左心房分流的情况增多。研究人员报告了中风合并偏头痛患者、中风但无偏头痛患者以及有偏头痛先兆但无中风的历史对照组和人群对照组中临床相关心房分流的患病率。在连续的60例中风患者中，42例（70%）存在大或中等大小的心房分流。39例患者接受了经导管封堵分流术，其中35例有卵圆孔未闭（平均直径9.8±4.1毫米），4例有房间隔缺损。如果心房分流与偏头痛患者的中风无关，那么偏头痛合并中风患者的分流患病率将与偏头痛但无中风患者相同。然而，发现中风合并偏头痛先兆患者的分流患病率（84%）远高于有偏头痛先兆但无中风患者（38.1%，p<0.001）、人群对照组（12.2%，p<0.001）以及中风但无偏头痛患者（55.6%，p<0.05）。无先兆偏头痛合并中风患者的分流患病率（75%）也显著高于人群对照组（p<0.001）和有偏头痛先兆但无中风患者（p<0.05）。总之，与普通人群相比，偏头痛患者中风发病率增加是因为他们存在大心房分流的患病率更高，因此反常栓塞风险增加。
