title: Right-to-left shunt does not increase white matter lesion load in migraine with aura patients.
abstract: BACKGROUND
  White matter lesions (WMLs) are commonly found on brain MRI of migraine patients. Migraine with aura (MA+) is associated with an increased frequency of right-to-left shunt (RLS) mostly due to patent foramen ovale. The relationship between WML load and RLS in MA+ is currently unknown.
  
  
  METHODS
  MA+ patients were consecutively enrolled as part of the Shunt Associated Migraine (SAM) study. Patients underwent a standardized headache and vascular risk factors questionnaire, contrast-enhanced transcranial Doppler, blood coagulation tests, and brain MRI. RLS was categorized into four grades: no shunt, <10 microbubbles (mb), >10 mb single spikes pattern, and >10 mb shower/curtain pattern. Standard and fluid-attenuated inversion recovery T2-weighted MRI sequences were inspected for WMLs by three independent raters blinded to RLS grade. WML load was scored in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Scheltens scale. Interobserver agreement was good to excellent (kappa = 0.64 to 0.96, p < 0.0001). WML load was then correlated between patients with and without RLS.
  
  
  RESULTS
  One hundred eighty-five patients (77% women) were included. PV-WML load was similar between patients with and without RLS. D-WML load decreased in patients with RLS (p = 0.045). On logistic regression analysis, only age was associated with WMLs (p < 0.001).
  
  
  CONCLUSIONS
  The presence of right-to-left shunt does not increase white matter lesion load in patients who have migraine with aura.
authors.affiliation: Stroke Center, Neurology Department, Ospedale Sacro Cuore, via Sempreboni 6, 37024 Negrar-Verona, Italy. alessandro.adami@sacrocuore.it
authors.forename: A
authors.initials: A
authors.lastname: Adami
authors.forename: G
authors.initials: G
authors.lastname: Rossato
authors.forename: R
authors.initials: R
authors.lastname: Cerini
authors.forename: V N
authors.initials: VN
authors.lastname: Thijs
authors.forename: R
authors.initials: R
authors.lastname: Pozzi-Mucelli
authors.forename: G P
authors.initials: GP
authors.lastname: Anzola
authors.forename: M
authors.initials: M
authors.lastname: Del Sette
authors.forename: C
authors.initials: C
authors.lastname: Finocchi
authors.forename: G
authors.initials: G
authors.lastname: Meneghetti
authors.forename: C
authors.initials: C
authors.lastname: Zanferrari
mesh_terms: D000328:Adult; D015984:Causality; D015897:Comorbidity; D003276:Contraceptives, Oral / Q000008:administration & dosage; D005260:Female; D054092:Foramen Ovale, Patent / Q000175:diagnosis / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000175:diagnosis* / Q000453:epidemiology*; D015999:Multivariate Analysis; D009413:Nerve Fibers, Myelinated / Q000000981:diagnostic imaging / Q000473:pathology*; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D003276:Contraceptives, Oral