White matter lesions in patients with right-to-left shunt-positive migraine：A study based on multimodal ultrasound imaging
10.19845/j.cnki.zfysjjbzz.2025.0180
- VernacularTitle:多模式超声影像探讨右向左分流阳性偏头痛患者与脑白质病变的相关研究
- Author:
Tong SUN
1
;
Pinjing HUI
1
Author Information
1. 苏州大学附属第一医院神经外科-颈脑血管超声科， 江苏 苏州 215006;苏州大学附属第一医院卒中中心， 江苏 苏州 215006
- Publication Type:Journal Article
- Keywords:
Right-to-left shunt;
Contrast-enhanced transcranial Doppler;
Contrast-enhanced transesophageal echocardiography;
White matter lesions
- From:
Journal of Apoplexy and Nervous Diseases
2025;42(11):984-990
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the severity of white matter lesions （WML） in patients with right-to-left shunt （RLS）-positive migraine. Methods A total of 415 patients with RLS-positive migraine who were consecutively admitted to Department of Neurology， The First Affiliated Hospital of Soochow University， from January 2022 to January 2025 were enrolled， and all these patients met the diagnostic criteria in The International Classification of Headache Disorders， 3 rd edition. RLS was diagnosed based on contrast-enhanced transcranial Doppler and contrast-enhanced transesophageal echocardiography， and the type and grade of RLS were assessed. After a series of statistical analyses was conducted， the factors with P<0.05 in the univariate logistic regression analysis were included in the multivariate binary logistic regression analysis to investigate the risk factors for the onset and severity of WML， with P<0.05 indicating statistical significance. Results The analysis of the baseline data of patients with different grades of WML showed that the grade of WML increased with age in the patients with RLS-positive migraine （P<0.05）. Comparison of multimodal ultrasound findings between the patients with different grades of WML showed that there were significant differences between the patients with different grades of WML in the factors such as large RLS， potential RLS， prolonged PFO tunnel， higher PFO at the right atrial side in resting state and after Valsalva maneuver， higher PFO at the left atrial side after Valsalva maneuver， early appearance of shunt， and longer duration of shunt （P<0.05）. For the establishment of a predictive model， large RLS shunt （P=0.037）， higher PFO at the right atrial side after Valsalva maneuver （P=0.018）， and longer duration of shunt （P<0.001） were independent risk factors for the onset of WML in patients with RLS-positive migraine， and further research showed that prolonged PFO tunnel （P<0.001） was a risk factor for the onset of moderate-to-severe WML in patients with RLS-positive migraine. Conclusion The predictive model established based on the ultrasound factors including large RLS shunt and prolonged PFO tunnel can be used as an imaging method to screen for WML， especially moderate-to-severe WML， which provides a theoretical basis for subsequent treatment.
