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Journal of Neurosurgical Sciences 1999 June;43(2):141-7

Copyright © 1999 EDIZIONI MINERVA MEDICA

lingua: Inglese

CBF changes during headache-free periods and spontaneous/induced attacks in migraine with and without aura: A TCD and SPECT comparison study

De Benedittis G. 1, Ferrari da Passano C. 2, Granata G. 3, Lorenzetti A. 1

1 Pain Research & Treatment Unit, Institute of Neurosurgery, University of Milan, Italy, Maggiore Policlinico Hospital, IRCCS, Milan, Italy; 2 Neurosurgical Clinic, University of Milan, S. Raffaele Hospital, Milan, Italy; 3 Neurosurgical Clinic, University of Milan, Monza, Italy


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Background. The aim of the ­present study was to com­pare cra­ni­al arter­ies blood flow veloc­ity as meas­ured by means of transcranial Doppler sonography (TCD) with mean region­al cerebral blood flow (rCBF) as meas­ured by means of single photon emission computed tomography (SPECT) in ­migraine with and with­out aura dur­ing head­ache-free peri­ods and spon­ta­ne­ous and/or ­induced ­attacks.
Methods. Regional cerebral blood flow (rCBF) and system­at­ic ultra­son­ic Doppler flow were stud­ied by Technetium-99m hex­a­meth­yl­prop­i­lam­i­nox­ime (99mTc-HM-PAO) single photon emission computed tomography (SPECT) and transcranial Doppler sonography (TCD) respec­tive­ly in con­trols (n=14) and in ­migraine with (n=13) and with­out aura (n=35) dur­ing head­ache free-inter­vals and spon­ta­ne­ous/his­ta­mine-­induced ­attacks.
Results. In the ­migraine with­out aura group, Doppler flow exam­ina­tions of the com­mon carot­id ­artery, exter­nal and inter­nal carot­id ­artery, oph­thal­mic ­artery and mid­dle cere­bral ­artery bilat­er­al­ly did not ­reveal sig­nif­i­cant chang­es as com­pared with con­trols. During ­attacks, TCD exam­ina­tions ­showed a mod­er­ate, ­although not sta­tis­ti­cal­ly sig­nif­i­cant, reduc­tion of blood flow veloc­ity in the mid­dle cere­bral ­artery and in the inter­nal carot­id ­artery bilat­er­al­ly as relat­ed to the inter­ic­tal phase, con­com­i­tant with an ­increase of the flow veloc­ity in the oph­thal­mic and exter­nal carot­id ­artery. SPECT of these ­patients did not show, on the aver­age, rCBF asym­me­tries dur­ing pain-free peri­ods, ­although pos­i­tive find­ings (i.e., focal hypo­per­fu­sion) were found in ­approximately half of the cases. During ­attacks, 74% of ­patients dis­played a uni­lat­er­al hypo­per­fu­sion, main­ly in the occip­i­tal ­region. Low-flow areas were gen­er­al­ly but not ­always con­sis­tent with the site of pain. In the ­migraine with aura group, sig­nif­i­cant reduc­tion of blood flow veloc­ity in mid­dle cere­bral ­artery was record­ed by TCD on the affect­ed side dur­ing ­attacks, as com­pared with the pain-free side. Hypoperfusion was reg­is­tered ­between ­attacks by SPECT in ­approximately 2/3 of the ­patients. During ­attacks, a ­marked reduc­tion of rCBF ­occurred in most ­patients (85%), main­ly in the parie­to-occip­i­tal ­region. The pos­te­ri­or rCBF asym­me­tries ­revealed at the SPECT and con­sis­tent with the gen­er­al reduc­tion of blood flow veloc­ity doc­u­ment­ed by TCD may be relat­ed to cereb­ro­vas­cu­lar tone instabil­ity.
Conclusions. Our find­ings do not sup­port the par­a­digm that ­migraine with and with­out aura are two dif­fer­ent ­entities.

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