title: Compromised dynamic cerebral autoregulation in patients with a right-to-left shunt: a potential mechanism of migraine and cryptogenic stroke.
abstract: OBJECTIVE
  The relationship between right-to-left shunts (RLS) and migraine and cryptogenic stroke is not well understood. In this study, we investigated whether RLS are associated with impairment of dynamic cerebral autoregulation (dCA), which may play a role in migraine and cryptogenic stroke.
  
  
  METHODS
  Sixty-six migraineurs were enrolled in the study, including 36 non-RLS patients and 30 RLS patients. Non-invasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each patient by using transcranial Doppler and servo-controlled plethysmograph, respectively. Transfer function analysis was applied to derive autoregulatory parameters of gain, phase difference (PD), and autoregulation index.
  
  
  RESULTS
  The PD in migraineurs with RLS was 50.6 ± 22.9 degrees, which was significantly lower than that observed in the non-RLS group (67.2 ± 18.2 degrees, P<0.001). The PD in the large RLS group (45.4 ± 22.6 degrees) was significantly lower than that of the small RLS group (64.9 ± 17.1 degrees, P<0.01) and non-RLS group (P<0.001); however, the PD in the small RLS group was similar to that of the non-RLS group. The PD in the permanent group (48.8 ± 19.9 degrees) was similar to that of the latent group (52.6 ± 26.1 degrees), and both were significantly lower than that of the non-RLS group (P<0.05). The autoregulation index results were similar to the PD findings.
  
  
  CONCLUSIONS
  dCA is impaired in migraineurs with large RLS, and this may represent a potential mechanism linking RLS, migraine, and cryptogenic stroke.
authors.affiliation: Neuroscience Center, Department of Neurology, the First Norman Bethune Hospital of Jilin University, Chang Chun, China.
authors.forename: Zhen-Ni
authors.initials: ZN
authors.lastname: Guo
authors.affiliation: Center for Neurovascular Ultrasound, the First Norman Bethune Hospital of Jilin University, Chang Chun, China.
authors.forename: Yingqi
authors.initials: Y
authors.lastname: Xing
authors.affiliation: Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Xueyuan Avenue, Shenzhen University Town, Shenzhen, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Neuroscience Center, Department of Neurology, the First Norman Bethune Hospital of Jilin University, Chang Chun, China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Wang
authors.affiliation: Neuroscience Center, Department of Neurology, the First Norman Bethune Hospital of Jilin University, Chang Chun, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Yan
authors.affiliation: Neuroscience Center, Department of Neurology, the First Norman Bethune Hospital of Jilin University, Chang Chun, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Jin
authors.affiliation: Neuroscience Center, Department of Neurology, the First Norman Bethune Hospital of Jilin University, Chang Chun, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000503:physiopathology*; D020521:Stroke / Q000503:physiopathology*; D055815:Young Adult