Journal of Stroke (Sep 2019)
History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)
- Valeria De Giuli,
- Michele Besana,
- Mario Grassi,
- Marialuisa Zedde,
- Andrea Zini,
- Corrado Lodigiani,
- Simona Marcheselli,
- Anna Cavallini,
- Giuseppe Micieli,
- Maurizia Rasura,
- Maria Luisa DeLodovici,
- Giampaolo Tomelleri,
- Nicoletta Checcarelli,
- Alberto Chiti,
- Elisa Giorli,
- Massimo Del Sette,
- Lucia Tancredi,
- Antonella Toriello,
- Massimiliano Braga,
- Andrea Morotti,
- Loris Poli,
- Filomena Caria,
- Massimo Gamba,
- Rosalba Patella,
- Alessandra Spalloni,
- Anna Maria Simone,
- Rosario Pascarella,
- Sandro Beretta,
- Enrico Fainardi,
- Alessandro Padovani,
- Roberto Gasparotti,
- Alessandro Pezzini
Affiliations
- Valeria De Giuli
- Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy
- Michele Besana
- Section of Neuroradiology, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Mario Grassi
- Medical Statistics and Genomics Unit, Department of Nervous System and Behavioral Sciences, University of Pavia, Italy
- Marialuisa Zedde
- Neurology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
- Andrea Zini
- IRCCS Neurological Sciences Institute, Neurology Unit and Stroke City Network, Ospedale Maggiore, Bologna, Italy
- Corrado Lodigiani
- Thrombosis Center, IRCCS Humanitas Research Hospital, Milano, Italy
- Simona Marcheselli
- Emergency Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Milano, Italy
- Anna Cavallini
- Stroke Unit, IRCCS Institute “C. Mondino”, Pavia, Italy
- Giuseppe Micieli
- Emergency Neurology, IRCCS Institute “C. Mondino”, Pavia, Italy
- Maurizia Rasura
- Stroke Unit, “Sant’Andrea” Hospital, University of Rome “La Sapienza”, Roma, Italy
- Maria Luisa DeLodovici
- Neurology Unit, Ospedale di Circolo, Varese, Italy
- Giampaolo Tomelleri
- Neurology Unit, University Hospital “Borgo Trento”, Verona, Italy
- Nicoletta Checcarelli
- Neurology Unit, “Valduce” Hospital, Como, Italy
- Alberto Chiti
- Neurology Unit, University Hospital, Pisa, Italy
- Elisa Giorli
- Neurology Unit, Ospedale S. Andrea, La Spezia, Italy
- Massimo Del Sette
- Neurology Unit, “Galliera” Hospital, Genova, Italy
- Lucia Tancredi
- Neurology Unit, ASST Lariana and “San Paolo” Hospital, ASST “Santi Paolo e Carlo”, Milano, Italy
- Antonella Toriello
- Neurology Unit, University Hospital “San Giovanni di Dio e Ruggu d’Aragona”, Salerno, Italy
- Massimiliano Braga
- Neurology Unit, Stroke Unit, Azienda Socio-Sanitaria Territoriale (ASST) Vimercate, Vimercate, Italy
- Andrea Morotti
- Stroke Unit, IRCCS Institute “C. Mondino”, Pavia, Italy
- Loris Poli
- Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy
- Filomena Caria
- Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy
- Massimo Gamba
- Stroke Unit, Vascular Neurology, “Spedali Civili”, Brescia, Italy
- Rosalba Patella
- Stroke Unit, “Sant’Andrea” Hospital, University of Rome “La Sapienza”, Roma, Italy
- Alessandra Spalloni
- Stroke Unit, “Sant’Andrea” Hospital, University of Rome “La Sapienza”, Roma, Italy
- Anna Maria Simone
- IRCCS Neurological Sciences Institute, Neurology Unit and Stroke City Network, Ospedale Maggiore, Bologna, Italy
- Rosario Pascarella
- Neurology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
- Sandro Beretta
- Neurology Unit, Stroke Unit, Azienda Socio-Sanitaria Territoriale (ASST) Vimercate, Vimercate, Italy
- Enrico Fainardi
- Department of Biomedical, Experimental and Clinical Sciences, Neuroradiology Unit, University Hospital “Careggi”, University of Firenze, Firenze, Italy
- Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy
- Roberto Gasparotti
- Section of Neuroradiology, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurological Clinic, University of Brescia, Brescia, Italy
- DOI
- https://doi.org/10.5853/jos.2019.00332
- Journal volume & issue
-
Vol. 21,
no. 3
pp. 324 – 331
Abstract
Background and Purpose Migraine has been shown to increase cerebral excitability, promote rapid infarct expansion into tissue with perfusion deficits, and result in larger infarcts in animal models of focal cerebral ischemia. Whether these effects occur in humans has never been properly investigated. Methods In a series of consecutive patients with acute ischemic stroke, enrolled in the setting of the Italian Project on Stroke at Young Age, we assessed acute as well as chronic infarct volumes by volumetric magnetic resonance imaging, and compared these among different subgroups identified by migraine status. Results A cohort of 591 patients (male, 53.8%; mean age, 37.5±6.4 years) qualified for the analysis. Migraineurs had larger acute infarcts than non-migraineurs (median, 5.9 cm3 [interquartile range (IQR), 1.4 to 15.5] vs. 2.6 cm3 [IQR, 0.8 to 10.1], P<0.001), and the largest volumes were observed in patients with migraine with aura (median, 9.0 cm3 [IQR, 3.4 to 16.6]). In a linear regression model, migraine was an independent predictor of increased log (acute infarct volumes) (median ratio [MR], 1.64; 95% confidence interval [CI], 1.22 to 2.20), an effect that was more prominent for migraine with aura (MR, 2.92; 95% CI, 1.88 to 4.54). Conclusions These findings reinforce the experimental observation of larger acute cerebral infarcts in migraineurs, extend animal data to human disease, and support the hypothesis of increased vulnerability to ischemic brain injury in people suffering migraine.
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