Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure.
Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure.
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DOI：
10.2147/opth.s30999
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Tobis JM
中科院分区：
文献类型：
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作者：
Mojadidi MK;Khessali H;Gevorgyan R;Levinson RD;Tobis JM
视频从右到左的分流通常由卵圆孔未闭（PFO）引起，与偏头痛和视觉先兆有关。目前尚不清楚有视觉先兆而无头痛的患者是否与有先兆的典型偏头痛患者行为相似。本研究的目的是评估有偏头痛先兆但无头痛的患者右向左分流的发生率，并评估PFO封堵术的反应。审查了因疑似心内右向左分流而转诊至加州大学洛杉矶分校介入心脏病学项目的患者记录。将有或无偏头痛的视觉先兆的个体分为三组：A组（先兆+偏头痛），头痛期间或60分钟内的偏头痛先兆; B组（与头痛无关的偏头痛先兆），偏头痛先兆和头痛时间无关; C组（仅偏头痛先兆），无头痛史的孤立性偏头痛视觉先兆。使用经颅多普勒和搅拌盐水试验评估右向左分流的存在。80例患者接受了PFO封堵术。术后3个月和12个月评估残留头痛和偏头痛视觉先兆。对照组包括200名转诊接受诊断性心导管插入术的患者。在590例转诊患者中，225例有偏头痛视觉先兆伴或不伴头痛。B组（21/29，72%）和C组（14/21，67%）的右向左分流发生率相似（P = 0.66）。由于选择偏倚，A组患者的右向左分流发生率较高（168/175，96%）。对照组中右向左分流的发生率（36/200，18%）显著（P < 0.0001）低于A、B和C组。在PFO闭合后12个月，A、B和C组分别有52%、75%和80%的患者的视觉先兆消退（差异无统计学意义）。在有偏头痛先兆但无头痛的患者中，PFO的患病率增加。PFO的闭合与视觉先兆的改善相关，表明PFO的存在与视觉先兆和偏头痛之间存在因果关系。眼科医生应该意识到右向左分流与视觉先兆的关系。
Video Right to left shunting, usually caused by a patent foramen ovale (PFO), is associated with migraine and visual aura. It is unknown if patients who present with visual aura without headache behave similarly to those experiencing typical migraine headache with aura. The purpose of this study was to assess the prevalence of right to left shunting in patients who present with migraine aura without headache and evaluate the response to PFO closure. The records of patients referred to the Interventional Cardiology program at the University of California at Los Angeles for suspected intracardiac right to left shunt were reviewed. Individuals with visual auras with or without migraine headaches were divided into three groups: group A (aura + migraine), migraine aura during or within 60 minutes of headache; group B (migraine aura unrelated to headache), migraine aura and headache temporally unrelated; and group C (migraine aura only), isolated migraine visual aura without a history of headaches. The presence of right to left shunt was assessed using transcranial Doppler with an agitated saline test. PFO closure was performed in 80 patients. Residual headache and migraine visual aura were assessed 3 and 12 months after the procedure. The control group consisted of 200 patients referred for diagnostic cardiac catheterization. Of 590 referred patients, 225 had migraine visual aura with or without headache. The prevalence of right to left shunt was similar (P = 0.66) in groups B (21/29, 72%) and C (14/21, 67%). Group A patients had a higher prevalence of right to left shunt (168/175, 96%) due to selection bias. The prevalence of right to left shunt in the control group was significantly (P < 0.0001) lower (36/200, 18%) than in groups A, B, and C. At 12 months after PFO closure, visual aura was resolved in 52%, 75%, and 80% of patients in groups A, B, and C, respectively (difference not statistically significant). There is an increased prevalence of PFO among patients with migraine aura without headache. The closure of PFO correlates with improvement of the visual aura, suggesting a causative association between the presence of PFO and both visual aura and migraine headaches. Ophthalmologists should be aware of the association of right to left shunts with visual aura.