Heckmann J G, Hilz M J, Katalinic A, Marthol H, Mück-Weymann M, Neundörfer B
Department of Neurology, University Erlangen-Nuremberg, Germany.
Cephalalgia. 1998 Apr;18(3):133-7. doi: 10.1046/j.1468-2982.1998.1803133.x.
Transcranial Doppler sonography (TCD) studies may help to elucidate the nature and role of vascular abnormalities in migraine. Our aim in this study was to evaluate cerebrovascular autoregulative response in migraine patients with and without aura to blood pressure increase using stress TCD.
Using transcranial Doppler ultrasound at rest and during ergometer stress (stress TCD), we studied the changes in mean flow velocities and resistance index (RI) in relation to physical stress in the middle cerebral artery. Fifteen migraine patients without aura, 15 migraine patients with aura, and 15 healthy control subjects were examined. Patients suffered from predominantly unilateral headache and were studied during an attack-free period. The Pourcelot's RI as a measure of cerebrovascular reactivity was calculated by dividing the difference between systolic and diastolic velocity by the systolic velocity.
None of the subgroups showed any difference during ergometer exercise with regard to blood pressure, endtidal CO2, heart rate, or mean flow velocity. In all subgroups, sufficient physical stress was achieved. With respect to RI change, migraine patients without aura and healthy controls did not differ (p > 0.05). However, the RI change of migraine patients with aura was significantly lower than the RI change of migraine patients without aura or healthy subjects (p > 0.05). The discrimination analysis showed in addition that RI change (absolute and as a percentage) and mean flow velocity change (as a percentage) could be used as diagnostic variables to detect patients with aura symptoms.
Differences exist in cerebrovascular reactivity in migraine patients with aura that may contribute to the neurologic disturbances in these patients during attack. We propose that there is disorder of myogenic cerebrovascular autoregulation in migraine patients with aura during headache-free intervals.
经颅多普勒超声（TCD）研究可能有助于阐明偏头痛中血管异常的性质和作用。本研究的目的是使用应激TCD评估有无先兆偏头痛患者对血压升高的脑血管自动调节反应。
我们使用静息状态下及测力计应激期间的经颅多普勒超声（应激TCD），研究大脑中动脉平均流速和阻力指数（RI）相对于身体应激的变化。对15例无先兆偏头痛患者、15例有先兆偏头痛患者和15例健康对照者进行了检查。患者主要为单侧头痛，且在无发作期进行研究。通过将收缩期和舒张期速度之差除以收缩期速度来计算作为脑血管反应性指标的普尔塞洛特RI。
在测力计运动期间各亚组在血压、呼气末二氧化碳、心率或平均流速方面均无差异。在所有亚组中，均达到了足够的身体应激。关于RI变化，无先兆偏头痛患者与健康对照者无差异（p>0.05）。然而，有先兆偏头痛患者的RI变化明显低于无先兆偏头痛患者或健康受试者的RI变化（p>0.05）。此外，判别分析表明RI变化（绝对值和百分比）以及平均流速变化（百分比）可作为检测有先兆症状患者的诊断变量。
有先兆偏头痛患者的脑血管反应性存在差异，这可能导致这些患者发作期间的神经功能障碍。我们提出，在无头痛间期，有先兆偏头痛患者存在肌源性脑血管自动调节紊乱。
