Olesen J, Friberg L, Olsen T S, Andersen A R, Lassen N A, Hansen P E, Karle A
Department of Neurology, Gentofte Hospital, Copenhagen, Denmark.
Brain. 1993 Feb;116 ( Pt 1):187-202. doi: 10.1093/brain/116.1.187.
Fifteen consecutive patients with a diagnostic problem of ischaemia-induced migraine with aura (symptomatic migraine) or migraine-associated ischaemia (migrainous infarction) were studied in order to elucidate the mechanisms. Three had a 1 month flurry of daily attacks of migraine auras with or without headache. A severe internal carotid stenosis/occlusion and reduced regional cerebral blood flow (rCBF) was demonstrated. Borderline ischaemia may thus prime the brain for developing migrainous aura with or without migraine (symptomatic migraine). Four patients had a combination of permanent deficits after the very first migraine attack, severe atherosclerosis, risk factors for stroke, high age and no family history of migraine. In these cases the evidence indicates that thromboembolic ischaemia had triggered an attack of migraine with aura (likely symptomatic migraine). Three young females presented long-lasting typical and severe idiopathic migraine with aura. Attack-associated rCBF reduction was likely to have caused permanent, mild, visual or somatosensory deficits (migrainous infarction). In five patients the relationship between migraine and stroke remained unresolved. It seems that ischaemia-induced migraine attacks may be more frequent than migraine-induced ischaemic insults. Therefore, migraine is not as strong a risk factor for stroke as indicated by the mere coincidence of the two disorders.
对15例患有缺血性偏头痛伴先兆（症状性偏头痛）或偏头痛相关性缺血（偏头痛性梗死）诊断问题的连续患者进行了研究，以阐明其机制。3例患者出现为期1个月的每日发作的偏头痛先兆，伴或不伴有头痛。证实存在严重的颈内动脉狭窄/闭塞以及局部脑血流量（rCBF）降低。因此，临界性缺血可能使大脑易于发生伴或不伴偏头痛（症状性偏头痛）的偏头痛性先兆。4例患者在首次偏头痛发作后出现永久性缺损、严重动脉粥样硬化、中风危险因素、高龄且无偏头痛家族史。在这些病例中，证据表明血栓栓塞性缺血引发了一次伴先兆的偏头痛发作（可能是症状性偏头痛）。3例年轻女性表现为长期的典型重度特发性偏头痛伴先兆。发作相关的rCBF降低可能导致了永久性、轻度、视觉或躯体感觉缺损（偏头痛性梗死）。5例患者中偏头痛与中风之间的关系仍未明确。似乎缺血性偏头痛发作可能比偏头痛性缺血性损伤更为常见。因此，偏头痛作为中风的危险因素并不像这两种疾病仅仅同时出现所表明的那么强。
