1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
2 Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Cephalalgia. 2018 Feb;38(2):283-291. doi: 10.1177/0333102416686342. Epub 2016 Dec 22.
Background We have recently shown that the presence of headache in ischemic stroke is associated with lesions of the insular cortex. The aim of this post-hoc subgroup analysis was to investigate the association of specific headache features with stroke location in patients with acute ischemic stroke. Methods In this observational study, patients (mean age: 61.5, 58% males) with ischemic stroke and acute headache (n = 49) were investigated. Infarcts were manually outlined on 3D diffusion weighted magnetic resonance imaging (MRI) scans and transformed into standard stereotaxic space; lesions of the left hemisphere were mirrored in the x-axis to allow a voxel-wise group analysis of all patients. We analyzed the association of lesion location and the following phenotypical characteristics by voxel-based symptom lesion mapping: Headache intensity, different qualities of headache (pulsating, tension-type like and stabbing), and the presence of nausea, of cranial autonomic symptoms and of light or noise sensitivity. Results Headache intensity was associated with lesions of the posterior insula, the operculum and the cerebellum. "Pulsating" headache occurred with widespread cortical and subcortical strokes. The presence of "tension-like" and "stabbing" headache was not related to specific lesion patterns. Nausea was associated with lesions in the posterior circulation territory. Cranial-autonomic symptoms were related to lesions of the parietal lobe, the somatosensory cortex (SI) and the middle temporal cortex. The presence of noise sensitivity was associated with cerebellar lesions, whereas light sensitivity was not related to specific lesions in our sample. Conclusion Headache phenotype in ischemic stroke appears to be related to specific ischemic lesion patterns.
背景 我们最近发现，缺血性中风患者头痛的存在与脑岛皮层病变有关。本事后亚组分析的目的是研究急性缺血性中风患者头痛的特定特征与中风位置之间的关联。
方法 在这项观察性研究中，我们对患有缺血性中风和急性头痛的患者（平均年龄：61.5 岁，58%为男性，n=49）进行了研究。在 3D 弥散加权磁共振成像（MRI）扫描上手动勾画梗塞灶，并将其转化为标准的立体定向空间；将左侧半球的病灶在 x 轴上镜像，以允许对所有患者进行基于体素的组分析。我们通过基于体素的症状-病变映射分析了病变位置与以下表型特征的关联：头痛强度、不同性质的头痛（搏动性、紧张型和刺痛性）、恶心、颅自主神经症状、对光或声音的敏感性。
结果 头痛强度与后岛叶、脑岛皮质和小脑病变有关。“搏动性”头痛与广泛的皮质和皮质下中风有关。“紧张型”和“刺痛型”头痛的存在与特定的病变模式无关。恶心与后循环区域的病变有关。颅自主神经症状与顶叶、体感皮层（SI）和颞中皮层的病变有关。对声音的敏感性与小脑病变有关，而对光的敏感性与我们样本中的特定病变无关。
结论 缺血性中风患者的头痛表型似乎与特定的缺血性病变模式有关。
