title: Association of clinical headache features with stroke location: An MRI voxel-based symptom lesion mapping study.
abstract: Background We have recently shown that the presence of headache in ischemic stroke is associated with lesions of the insular cortex. The aim of this post-hoc subgroup analysis was to investigate the association of specific headache features with stroke location in patients with acute ischemic stroke. Methods In this observational study, patients (mean age: 61.5, 58% males) with ischemic stroke and acute headache (n = 49) were investigated. Infarcts were manually outlined on 3D diffusion weighted magnetic resonance imaging (MRI) scans and transformed into standard stereotaxic space; lesions of the left hemisphere were mirrored in the x-axis to allow a voxel-wise group analysis of all patients. We analyzed the association of lesion location and the following phenotypical characteristics by voxel-based symptom lesion mapping: Headache intensity, different qualities of headache (pulsating, tension-type like and stabbing), and the presence of nausea, of cranial autonomic symptoms and of light or noise sensitivity. Results Headache intensity was associated with lesions of the posterior insula, the operculum and the cerebellum. "Pulsating" headache occurred with widespread cortical and subcortical strokes. The presence of "tension-like" and "stabbing" headache was not related to specific lesion patterns. Nausea was associated with lesions in the posterior circulation territory. Cranial-autonomic symptoms were related to lesions of the parietal lobe, the somatosensory cortex (SI) and the middle temporal cortex. The presence of noise sensitivity was associated with cerebellar lesions, whereas light sensitivity was not related to specific lesions in our sample. Conclusion Headache phenotype in ischemic stroke appears to be related to specific ischemic lesion patterns.
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Seifert
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.|2 Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Etienne M
authors.initials: EM
authors.lastname: Schönbach
authors.affiliation: 3 Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: 3 Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Förschler
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Tölle
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Regina
authors.initials: R
authors.lastname: Feurer
authors.affiliation: 4 Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gempt
authors.affiliation: 5 Department of Neurology, University Hospital Basel, Switzerland.|6 Medical Image Analysis Center, University Hospital Basel, Switzerland.
authors.forename: Athina
authors.initials: A
authors.lastname: Papadopoulou
authors.affiliation: 5 Department of Neurology, University Hospital Basel, Switzerland.|6 Medical Image Analysis Center, University Hospital Basel, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Magon
authors.affiliation: 5 Department of Neurology, University Hospital Basel, Switzerland.|6 Medical Image Analysis Center, University Hospital Basel, Switzerland.|7 Department of Neurology, DKD HELIOS Klinik, Wiesbaden, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Sprenger
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Poppert
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Ischemic stroke; headache phenotype; voxel based symptom lesion mapping