Riederer Franz, Beiersdorf Johannes, Scutelnic Adrian, Schankin Christoph J
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland.
Department of Neurology, University Hospital Zurich, Medical Faculty, University of Zurich, CH 8091 Zurich, Switzerland.
Diagnostics (Basel). 2023 Sep 2;13(17):2844. doi: 10.3390/diagnostics13172844.
Roughly one-third of migraine patients suffer from migraine with aura, characterized by transient focal neurological symptoms or signs such as visual disturbance, sensory abnormalities, speech problems, or paresis in association with the headache attack. Migraine with aura is associated with an increased risk for stroke, epilepsy, and with anxiety disorder. Diagnosis of migraine with aura sometimes requires exclusion of secondary causes if neurological deficits present for the first time or are atypical. It was the aim of this review to summarize EEG an MRI findings during migraine aura in the context of pathophysiological concepts. This is a narrative review based on a systematic literature search. During visual auras, EEG showed no consistent abnormalities related to aura, although transient focal slowing in occipital regions has been observed in quantitative studies. In contrast, in familial hemiplegic migraine (FHM) and migraine with brain stem aura, significant EEG abnormalities have been described consistently, including slowing over the affected hemisphere or bilaterally or suppression of EEG activity. Epileptiform potentials in FHM are most likely attributable to associated epilepsy. The initial perfusion change during migraine aura is probably a short lasting hyperperfusion. Subsequently, perfusion MRI has consistently demonstrated cerebral hypoperfusion usually not restricted to one vascular territory, sometimes associated with vasoconstriction of peripheral arteries, particularly in pediatric patients, and rebound hyperperfusion in later phases. An emerging potential MRI signature of migraine aura is the appearance of dilated veins in susceptibility-weighted imaging, which may point towards the cortical regions related to aura symptoms ("index vein"). Conclusions: Cortical spreading depression (CSD) cannot be directly visualized but there are probable consequences thereof that can be captured Non-invasive detection of CSD is probably very challenging in migraine. Future perspectives will be elaborated based on the studies summarized.
大约三分之一的偏头痛患者患有伴先兆偏头痛，其特征是在头痛发作时伴有短暂的局灶性神经症状或体征，如视觉障碍、感觉异常、言语问题或轻瘫。伴先兆偏头痛与中风、癫痫和焦虑症的风险增加有关。如果首次出现神经功能缺损或表现不典型，伴先兆偏头痛的诊断有时需要排除继发性病因。本综述的目的是在病理生理概念的背景下总结偏头痛先兆期间的脑电图（EEG）和磁共振成像（MRI）结果。这是一项基于系统文献检索的叙述性综述。在视觉先兆期间，EEG未显示与先兆相关的一致异常，尽管在定量研究中观察到枕叶区域有短暂的局灶性减慢。相比之下，在家族性偏瘫性偏头痛（FHM）和伴有脑干先兆的偏头痛中，一直有显著的EEG异常描述，包括患侧半球或双侧的减慢或EEG活动的抑制。FHM中的癫痫样电位很可能归因于相关的癫痫。偏头痛先兆期间最初的灌注变化可能是短暂的高灌注。随后，灌注MRI一直显示脑灌注不足，通常不限于一个血管区域，有时与外周动脉血管收缩有关，特别是在儿科患者中，后期会出现反弹性高灌注。偏头痛先兆的一个新出现的潜在MRI特征是在磁敏感加权成像中出现扩张的静脉，这可能指向与先兆症状相关的皮质区域（“指示静脉”）。结论：皮质扩散性抑制（CSD）无法直接可视化，但可以捕捉到其可能的后果。在偏头痛中，CSD的无创检测可能非常具有挑战性。将根据总结的研究阐述未来的前景。
