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. 2024 Aug 22:15:1419533.
doi: 10.3389/fneur.2024.1419533. eCollection 2024.

Relationship between right-to-left shunt and white matter lesions in patients with migraine: a single-center study

Zhihong Liu  1 , Mingzhu Jiang  2 , Jing He  2 , Yuchan Lin  2 , Lou He  2 , Yan Li  2 , Qi Pan  2 , Shan Wu  2
Affiliations

Relationship between right-to-left shunt and white matter lesions in patients with migraine: a single-center study

Zhihong Liu et al. Front Neurol. .

Erratum in

Abstract

Background: Migraine patients have an increased long-term risk of cardio and cerebrovascular events. However, whether these patients are more susceptible to white matter lesions (WMLs) remains debated. To explore this question, our study assessed the proportion of RLS in migraine patients and explored the association between right-to-left shunt (RLS) and WMLs.

Methods: In this study, we included 998 migraine patients. Contrast transcranial doppler (c-TCD) was used to diagnose RLS and assess the extent of the shunt in RLS patients. Of the 998 patients, 505 underwent cranial magnetic resonance imaging (MRI) assessments. WMLs were classified into periventricular white matter lesions (pvWMLs) and deep white matter lesions (dWMLs).

Results: Among the 998 migraine patients, 946 had migraine without aura (MO; mean age 36.68 ± 10.46 years; 80.5% female), and 52 had migraine with aura (MA; mean age 29.85 ± 8.59 years; 71.2% female). Compared with MO patients, MA patients had an earlier onset age (23.1 ± 7.97 vs. 28.44 ± 10.38 years, p < 0. 001) and a shorter disease duration (6.76 vs. 8.34 years, p = 0.024). The overall proportion of RLS patients was 41.9%, with a greater proportion of RLS patients in the MA group than in the MO group (55.8% vs. 41. 1%, p = 0.037). The percentage of RLS-positive patients with no/small shunt was greater in the MO group than in the MA group (81.5% vs. 65.4%, p = 0.004), whereas the percentage of RLS-positive patients with moderate/large shunt was greater in the MA group (34.6% vs. 18.5%, p = 0.024). The proportion of RLS patients was lower in the WML-positive group (n = 173) than in the WML-negative group (n = 332), but the difference was not significant (40.5% vs. 45.8%, p = 0.253).

Conclusion: This study revealed that 41.9% of migraine patients had RLS, and the proportion of RLS patients was 41. 1% in the MO group and 55.8% in the MA group. The rate of RLS positivity in migraine patients may not be related to the incidence of WMLs.

Keywords: contrast transcranial doppler; cranial magnetic resonance imaging; migraine; right-to-left shunt; white matter lesions.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Four-level RLS categorization based on the microbubble count. Grade 0 = negative; Grade I = 1–10 MBs; Grade II = more than 10 MBs but no rain curtain; Grade III = formation of a rain curtain. RLS, right-to-left shunt; MBs, microbubbles.
Figure 2
Figure 2
Representative images of white matter lesions. (A) Normal; (B) deep white matter lesion (dWMLs), multiple clear boundary signals observed in the bilateral radiative coronal region (red arrow); (C) paraventricular white matter lesion (pvWMLs), a hat-shaped high signal observed in the anterior horn of the right lateral ventricle (yellow arrow).
Figure 3
Figure 3
Flow chart of patient enrollment.
Figure 4
Figure 4
The proportions of patients with no/small RLS and moderate/large RLS in the MO and MA subgroups. The percentage of patients with no/small shunt in the MO group was significantly greater than that in the MA group; the percentage of patients with a moderate/large shunt in the MA group was significantly greater than that in the MO group. *p < 0.05.
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