Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104286. doi: 10.1016/j.jstrokecerebrovasdis.2019.07.002. Epub 2019 Jul 18.
Calcitonin gene-related peptide (CGRP) is involved in nociception and neurogenic inflammation in migraine, but also serves as a potent vasodilator acting on intracranial arteries. This latter effect raises concern about the possibility of drugs inhibiting CGRP precipitating cerebral ischemia. We describe a 41-year-old woman with migraine without aura who developed a right thalamic infarction following a first dose of erenumab, a CGRP-receptor blocker. Stroke onset occurred during a typical migraine. Imaging demonsrated right posterior cerebral artery near-occlusion initially with normalization of the vessel at follow-up imaging 2 months later, suggesting vasospasm as a possible mechanism. Extensive evaluation revealed no other specific cause of stroke or vascular risk factors aside from long-term use of oral contraceptive pills. CGRP inhibitors might be associated with ischemic stroke due to blockade of normal cerebral vasodilatory regulatory function.
降钙素基因相关肽（CGRP）参与偏头痛的痛觉和神经源性炎症，但也作为一种强有力的血管扩张剂作用于颅内动脉。这种作用使人担心抑制 CGRP 的药物是否会引发脑缺血。我们描述了一例 41 岁女性偏头痛患者，无先兆，在首次使用 CGRP 受体拮抗剂依那西普后出现右侧丘脑梗死。中风发作发生在典型的偏头痛期间。影像学显示右侧大脑后动脉近闭塞，2 个月后随访影像学显示血管正常，提示可能是血管痉挛作为一种可能的机制。广泛的评估除了长期使用口服避孕药外，没有发现中风或血管危险因素的其他特定原因。CGRP 抑制剂可能与缺血性中风有关，因为其阻断了正常的脑血管舒张调节功能。
