Major Finding: Patients who have migraine with aura and a heart with a large right-to-left shunt showed significant deficits in verbal learning and memory, compared with patients with no right-to-left shunting.
Data Source: Interim analysis of 40 patients in on ongoing prospective, double-blind, observational study.
Disclosures: The study was funded by the National Headache Foundation, Coherex Medical, NMT Medical, and the John L. Locke Jr. Charitable Trust. Dr. Jesurum has had financial associations with Coherex Medical, NMT Medical, Coaptus Medical, Terumo Cardiovascular Systems, and Boston Scientific Corp.
LOS ANGELES – Cognitive deficits can occur between episodes of migraine with aura in patients with a large right-to-left shunt in the heart, according to interim results from a small, prospective, double-blind, observational study.
In the Comorbidities Associated With Migraine and Patent Foramen Ovale (CAMP) study, 20 patients with large right-to-left shunts scored significantly lower on measures of auditory and verbal memory and learning than did 20 patients with no right-to-left shunt. There was a significant inverse relationship between test scores and the number of embolic tracks detected on transcranial Doppler sonography, Jill Jesurum, Ph.D., and her associates reported at the meeting.
No significant differences between groups were seen in tests of visual memory, learning, and processing speed. Patients with large right-to-left shunts scored higher on one of seven tests of cognitive efficiency and attention, but overall there seemed to be no significant difference between groups in this category. The neuropsychological tests used in the study emphasized cognitive function in brain regions supplied by the posterior circulation.
These early trends suggest temporal or hippocampal involvement and vulnerability to microembolic hypoperfusion, said Dr. Jesurum, scientific director of the Heart and Vascular Institute at Swedish Medical Center, Seattle.
However, the source of the right-to-left shunts has not yet been confirmed by echocardiography as perhaps being due to a patent foramen ovale, she said.
Dr. Jesurum advised caution in interpreting these interim results on such a small number of patients.
She speculated that circulatory shunting of unfiltered microaggregates and vasoactive chemicals to the cerebral vasculature may occur with right-to-left shunting and produce recurrent transient ischemia, theoretically increasing the risk of cognitive dysfunction.