SAN DIEGO—Migraine aura may correlate with larger infarct sizes in patients with ischemic stroke, according to a study presented at the 65th Annual Meeting of the American Academy of Neurology. Cortical spreading depression, which neurologists believe occurs in acute stroke and migraine aura, may be the common mechanism.
Stephanie Nahas, MD, Assistant Professor of Neurology at Thomas Jefferson University in Philadelphia, and colleagues interviewed 139 patients admitted for ischemic stroke evaluation regarding their history of headache, migraine, aura, and headache within 24 hours before or after stroke symptom onset (ie, stroke headache). The investigators calculated infarct volumes manually from MRI as a sum of the regions of interest multiplied by the slice heights. The group evaluated stroke location, history of migraine, history of aura, and stroke headache as potential predictors of infarct size.
Correlations Emerge
In the study population, prior migraine correlated with stroke headache. Posterior stroke location did not correlate with infarct size, but cortical stroke location did.
Aura independently correlated with infarct size. Without controlling for stroke location, the mean infarct size for patients without prior aura was 4.04 cm3, compared with 10.89 cm3 for those with prior aura. After controlling for stroke location, the researchers found that mean infarct size for patients without prior aura was 1.22 cm3, compared with 3.96 cm3 for patients with prior aura.
Implications for Clinical Practice
“These data show, for the first time, an association between history of aura and larger infarcts,” said Dr. Nahas. “If cortical spreading depression plays a role in enlargement of the stroke penumbra, then it may be that patients with aura are predisposed to develop depolarization at the infarct rim at a faster and more efficient rate, and thus larger infarcts.” If confirmed, the study results could change the management of acute stroke and poststroke care. It is possible that identifying patients at risk for large infarcts and administering preventive treatment may reduce stroke burden, Dr. Nahas concluded.
—Erik Greb
Senior Associate Editor