TY - JOUR
T1 - Stroke progression and clinical outcome in ischemic stroke patients with a history of migraine
AU - Mulder, Inge A
AU - Holswilder, Ghislaine
AU - van Walderveen, Marianne Aa
AU - van der Schaaf, Irene C
AU - Bennink, Edwin
AU - Horsch, Alexander D
AU - Kappelle, L Jaap
AU - Velthuis, Birgitta K
AU - Dankbaar, Jan Willem
AU - Terwindt, Gisela M
AU - Schonewille, Wouter J
AU - Visser, Marieke C
AU - Ferrari, Michel D
AU - Algra, Ale
AU - Wermer, Marieke Jh
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Wermer: ZonMW-Veni grant, ZonMw-VIDI grant, the Dutch Heart Foundation (2011T055) and the Dutch Brain foundation (F2014(1)-22). DUST study: Dutch Heart Foundation (2008T034) and NutsOhra Foundation (0903-012).
Publisher Copyright:
© 2019 World Stroke Organization.
PY - 2019/12
Y1 - 2019/12
N2 - Background: Patients with migraine might be more susceptible of spreading depolarizations, which are known to affect vascular and neuronal function and penumbra recovery after stroke. We investigated whether these patients have more severe stroke progression and less favorable outcomes after recanalization therapy. Methods: We included patients from a prospective multicenter ischemic stroke cohort. Lifetime migraine history was based on the International Classification of Headache Disorders II criteria. Patients without confirmed migraine diagnosis were excluded. Patients underwent CT angiography and CT perfusion <9 h of onset and follow-up CT after three days. On admission, presence of a perfusion deficit, infarct core and penumbra volume, and blood brain barrier permeability (BBBP) were assessed. At follow-up we assessed malignant edema, hemorrhagic transformation, and final infarct volume. Outcome at three months was evaluated with the modified Rankin Scale (mRS). We calculated adjusted relative risks (aRR) or difference of means (aB) with regression analyses. Results: We included 600 patients of whom 43 had migraine. There were no differences between patients with or without migraine in presence of a perfusion deficit on admission (aRR: 0.98, 95%CI: 0.77–1.25), infarct core volume (aB: -10.8, 95%CI: -27.04–5.51), penumbra volume (aB: -11.6, 95%CI: -26.52–3.38), mean blood brain barrier permeability (aB: 0.08, 95%CI: -3.11–2.96), malignant edema (0% vs. 5%), hemorrhagic transformation (aRR: 0.26, 95%CI: 0.04–1.73), final infarct volume (aB: -14.8, 95%CI: 29.9–0.2) or outcome after recanalization therapy (mRS > 2, aRR: 0.50, 95%CI: 0.21–1.22). Conclusion: Elderly patients with a history of migraine do not seem to have more severe stroke progression and have similar treatment outcomes compared with patients without migraine.
AB - Background: Patients with migraine might be more susceptible of spreading depolarizations, which are known to affect vascular and neuronal function and penumbra recovery after stroke. We investigated whether these patients have more severe stroke progression and less favorable outcomes after recanalization therapy. Methods: We included patients from a prospective multicenter ischemic stroke cohort. Lifetime migraine history was based on the International Classification of Headache Disorders II criteria. Patients without confirmed migraine diagnosis were excluded. Patients underwent CT angiography and CT perfusion <9 h of onset and follow-up CT after three days. On admission, presence of a perfusion deficit, infarct core and penumbra volume, and blood brain barrier permeability (BBBP) were assessed. At follow-up we assessed malignant edema, hemorrhagic transformation, and final infarct volume. Outcome at three months was evaluated with the modified Rankin Scale (mRS). We calculated adjusted relative risks (aRR) or difference of means (aB) with regression analyses. Results: We included 600 patients of whom 43 had migraine. There were no differences between patients with or without migraine in presence of a perfusion deficit on admission (aRR: 0.98, 95%CI: 0.77–1.25), infarct core volume (aB: -10.8, 95%CI: -27.04–5.51), penumbra volume (aB: -11.6, 95%CI: -26.52–3.38), mean blood brain barrier permeability (aB: 0.08, 95%CI: -3.11–2.96), malignant edema (0% vs. 5%), hemorrhagic transformation (aRR: 0.26, 95%CI: 0.04–1.73), final infarct volume (aB: -14.8, 95%CI: 29.9–0.2) or outcome after recanalization therapy (mRS > 2, aRR: 0.50, 95%CI: 0.21–1.22). Conclusion: Elderly patients with a history of migraine do not seem to have more severe stroke progression and have similar treatment outcomes compared with patients without migraine.
KW - CT angiography
KW - CT angiography and perfusion
KW - Cerebrovascular disease/stroke
KW - ischemic stroke
KW - migraine
KW - non-contrast CT
KW - stroke
KW - Cerebrovascular disease
UR - http://www.scopus.com/inward/record.url?scp=85066827767&partnerID=8YFLogxK
U2 - 10.1177/1747493019851288
DO - 10.1177/1747493019851288
M3 - Article
C2 - 31132969
SN - 1747-4930
VL - 14
SP - 946
EP - 955
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 9
ER -