Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Int J Stroke. 2019 Dec;14(9):946-955. doi: 10.1177/1747493019851288. Epub 2019 May 27.
Patients with migraine might be more susceptible of spreading depolarizations, which are known to affect vascular and neuronal function and penumbra recovery after stroke. We investigated whether these patients have more severe stroke progression and less favorable outcomes after recanalization therapy.
We included patients from a prospective multicenter ischemic stroke cohort. Lifetime migraine history was based on the International Classification of Headache Disorders II criteria. Patients without confirmed migraine diagnosis were excluded. Patients underwent CT angiography and CT perfusion <9 h of onset and follow-up CT after three days. On admission, presence of a perfusion deficit, infarct core and penumbra volume, and blood brain barrier permeability (BBBP) were assessed. At follow-up we assessed malignant edema, hemorrhagic transformation, and final infarct volume. Outcome at three months was evaluated with the modified Rankin Scale (mRS). We calculated adjusted relative risks (aRR) or difference of means (aB) with regression analyses.
We included 600 patients of whom 43 had migraine. There were no differences between patients with or without migraine in presence of a perfusion deficit on admission (aRR: 0.98, 95%CI: 0.77-1.25), infarct core volume (aB: -10.8, 95%CI: -27.04-5.51), penumbra volume (aB: -11.6, 95%CI: -26.52-3.38), mean blood brain barrier permeability (aB: 0.08, 95%CI: -3.11-2.96), malignant edema (0% vs. 5%), hemorrhagic transformation (aRR: 0.26, 95%CI: 0.04-1.73), final infarct volume (aB: -14.8, 95%CI: 29.9-0.2) or outcome after recanalization therapy (mRS > 2, aRR: 0.50, 95%CI: 0.21-1.22).
Elderly patients with a history of migraine do not seem to have more severe stroke progression and have similar treatment outcomes compared with patients without migraine.
偏头痛患者可能更容易发生已知会影响血管和神经元功能以及中风后半影区恢复的扩散去极化。我们研究了这些患者在再通治疗后是否有更严重的中风进展和预后不良。
我们纳入了来自前瞻性多中心缺血性中风队列的患者。终生偏头痛史基于国际头痛疾病分类 II 标准。排除未确诊偏头痛的患者。患者在发病后 9 小时内进行 CT 血管造影和 CT 灌注检查，并在第三天进行随访 CT。入院时，评估存在灌注不足、梗死核心和半影区体积以及血脑屏障通透性（BBBP）。在随访时，评估恶性水肿、出血性转化和最终梗死体积。三个月时的预后采用改良 Rankin 量表（mRS）评估。我们通过回归分析计算调整后的相对风险（aRR）或均值差异（aB）。
我们纳入了 600 名患者，其中 43 名有偏头痛。在入院时存在灌注不足的患者中，有偏头痛和无偏头痛的患者之间没有差异（aRR：0.98，95%CI：0.77-1.25），梗死核心体积（aB：-10.8，95%CI：-27.04-5.51），半影区体积（aB：-11.6，95%CI：-26.52-3.38），平均血脑屏障通透性（aB：0.08，95%CI：-3.11-2.96），恶性水肿（0% vs. 5%），出血性转化（aRR：0.26，95%CI：0.04-1.73），最终梗死体积（aB：-14.8，95%CI：29.9-0.2）或再通治疗后的预后（mRS>2，aRR：0.50，95%CI：0.21-1.22）。
有偏头痛病史的老年患者似乎没有更严重的中风进展，并且与无偏头痛的患者相比，治疗结果相似。
