1 Department of Neurology, Hospices Civils de Lyon, Lyon, France.
2 Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon, France.
Cephalalgia. 2018 Sep;38(10):1687-1695. doi: 10.1177/0333102417738251. Epub 2017 Oct 26.
Background Migraine with brainstem aura is defined as a migraine with aura including at least two of the following symptoms: dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia and/or decreased level of consciousness. Aim The aim of this study is to review data coming from clinical observations and functional mapping that support the role of the cerebral cortex in the initiation of brainstem aura symptoms. Results Vertigo can result from a vestibular cortex dysfunction, while tinnitus and hypacusis can originate within the auditory cortex. Diplopia can reflect a parieto-occipital involvement. Dysarthria can be caused by dysfunctions located in precentral gyri. Ataxia can reflect abnormal processing of vestibular, sensory, or visual inputs by the parietal lobe. Alteration of consciousness can be caused by abnormal neural activation within specific consciousness networks that include prefrontal and posterior parietal cortices. Conclusion Any symptom of so-called brainstem aura can originate within the cortex. Based on these data, we suggest that brainstem aura could have a cortical origin. This hypothesis would explain the co-occurrence of typical and brainstem aura during attacks and would fit with the theory of cortical spreading depression. We propose that migraine with brainstem aura should be classified as a typical migraine aura.
背景 伴有脑干先兆的偏头痛定义为具有先兆的偏头痛，包括以下至少两种症状：构音障碍、眩晕、耳鸣、听力减退、复视、共济失调和/或意识水平下降。目的 本研究旨在回顾临床观察和功能定位的数据，这些数据支持大脑皮层在脑干先兆症状发生中的作用。结果 眩晕可能是由于前庭皮层功能障碍引起的，而耳鸣和听力减退可能起源于听觉皮层。复视可反映顶枕叶受累。构音障碍可由中央前回的功能障碍引起。共济失调可能反映了顶叶对前庭、感觉或视觉输入的异常处理。意识改变可能是由于包括额前叶和顶后叶在内的特定意识网络内的异常神经激活引起的。结论 所谓脑干先兆的任何症状都可能起源于皮层。基于这些数据，我们提出脑干先兆可能具有皮质起源。这一假说可以解释发作期间典型和脑干先兆的同时发生，并与皮质扩散性抑制理论相吻合。我们建议将伴有脑干先兆的偏头痛归类为典型偏头痛先兆。
