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  • 1
    Online Resource
    Online Resource
    Interictal cortical hyperresponsiveness in migraine is directly related to the presence of aura
    SAGE Publications ; 2013
    In:  Cephalalgia Vol. 33, No. 6 ( 2013-04), p. 365-374
    Details
    In: Cephalalgia, SAGE Publications, Vol. 33, No. 6 ( 2013-04), p. 365-374
    Abstract: The objective of this study was to compare the interictal cortical response to a visual stimulus between migraine with aura (MWA), migraine without aura (MwoA), and control subjects. Methods In a prospective case-control study, blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) was used to assess the response to a visual stimulus and arterial spin labeled perfusion MR to determine resting cerebral blood flow. A standardized questionnaire was used to assess interictal visual discomfort. Results Seventy-five subjects (25 MWA, 25 MwoA, and 25 controls) were studied. BOLD fMRI response to visual stimulation within primary visual cortex was greater in MWA (3.09 ± 0.15%) compared to MwoA (2.36 ± 0.13%, p = 0.0008) and control subjects (2.47 ± 0.11%, p = 0.002); responses were also greater in the lateral geniculate nuclei in MWA. No difference was found between MwoA and control groups. Whole brain analysis showed that increased activation in MWA was confined to the occipital pole. Regional resting cerebral blood flow did not differ between groups. MWA and MwoA subjects had significantly greater levels of interictal visual discomfort compared to controls ( p = 0.008 and p = 0.005, respectively), but this did not correlate with BOLD response. Conclusions Despite similar interictal symptoms of visual discomfort, only MWA subjects have cortical hyperresponsiveness to visual stimulus, suggesting a direct connection between cortical hyperresponsiveness and aura itself.
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/0333102412474503
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2019999-5
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  • 2
    Online Resource
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    A web-based, branching logic questionnaire for the automated classification of migraine
    SAGE Publications ; 2019
    In:  Cephalalgia Vol. 39, No. 10 ( 2019-09), p. 1257-1266
    Details
    In: Cephalalgia, SAGE Publications, Vol. 39, No. 10 ( 2019-09), p. 1257-1266
    Abstract: To identify migraineurs and headache-free individuals with an online questionnaire and automated analysis algorithm. Methods We created a branching-logic, web-based questionnaire – the Penn Online Evaluation of Migraine – to obtain standardized headache history from a previously studied cohort. Responses were analyzed with an automated algorithm to assign subjects to one of several categories based on ICHD-3 (beta) criteria. Following a pre-registered protocol, the primary outcome was sensitivity and specificity for assignment of headache-free, migraine without aura, and migraine with aura labels, as compared to a prior classification by neurologist interview. Results Of 118 subjects contacted, 90 (76%) completed the questionnaire; of these 31 were headache-free controls, 29 migraine without aura, and 30 migraine with aura. Mean age was 41 ± 6 years and 76% were female. There were no significant demographic differences between groups. The median time to complete the questionnaire was 2.5 minutes (IQR: 1.5–3.4 minutes). Sensitivity of the Penn Online Evaluation of Migraine tool was 42%, 59%, 70%, and 83%, and specificity was 100%, 84%, 93%, and 90% for headache-free controls, migraine without aura, migraine with aura, and migraine overall, respectively. Conclusions The Penn Online Evaluation of Migraine web-based questionnaire, and associated analysis routine, identifies headache-free and migraine subjects with good specificity. It may be useful for classifying subjects for large-scale research studies. Research study pre-registration: https://osf.io/sq9ef The following research study is a not a clinical trial.
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/0333102419847749
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 3
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    Online Resource
    Reversible Cerebral Vasoconstriction Syndrome Exacerbation After Calcitonin Gene–Related Peptide Inhibitor Administration
    SAGE Publications ; 2023
    In:  The Neurohospitalist Vol. 13, No. 4 ( 2023-10), p. 415-418
    Details
    In: The Neurohospitalist, SAGE Publications, Vol. 13, No. 4 ( 2023-10), p. 415-418
    Abstract: Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a non-inflammatory vasculopathy. While most patients have good clinical outcomes, RCVS can be associated with severe brain injury from ischemic stroke, subarachnoid, and intracerebral hemorrhage. Purpose: A number of vasoactive medications have been implicated in RCVS, including triptans, amphetamines, antidepressants, and decongestants. Given the role of CGRP in modulating cerebral vasodilation, the possibility of CGRP inhibitors contributing to RCVS has been raised. Research Design: Case report at the University of Pennsylvania. Study Sample: Patient at the University of Pennsylvania. Results: We report a patient with RCVS in which severe exacerbation resulting in multifocal ischemic stroke occurred following administration of the calcitonin gene–related peptide (CGRP) inhibitor fremanezumab. Conclusions: It is unclear whether fremanezumab played a role in this patient's case, but CGRP-inhibitor use should be considered as a potential precipiating factor.
    Type of Medium: Online Resource
    ISSN: 1941-8744 , 1941-8752
    URL: Article
    DOI: 10.1177/19418744231173832
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2629083-2
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  • 4
    Online Resource
    Online Resource
    Measurement of visual sensitivity in migraine: Validation of two scales and correlation with visual cortex activation
    SAGE Publications ; 2015
    In:  Cephalalgia Vol. 35, No. 7 ( 2015-06), p. 585-592
    Details
    In: Cephalalgia, SAGE Publications, Vol. 35, No. 7 ( 2015-06), p. 585-592
    Abstract: The objectives of this article are to compare interictal and ictal visual sensitivity between migraine and controls using two published questionnaires, and to correlate responses with a physiologic measure of visual cortex activation. Methods Migraine with (MWA, n = 51) and without (MwoA, n = 45) aura and control individuals ( n = 45) were enrolled and underwent BOLD fMRI with a visual stimulus. The visual discomfort score (VDS) assessed interictal and the migraine photophobia score (MPS) assessed ictal visual sensitivity. Result VDS was significantly higher both in MWA and MwoA vs controls (both p  〈  0.0001). MPS was greater in MWA vs MwoA ( p = 0.008). Ictal and interictal visual sensitivity strongly correlated in MWA ( p = 0.004) but not MwoA patients ( p = 0.12). BOLD activation in visual cortex was greater in MWA vs controls (2.7% vs 2.3%, p = 0.003) but similar between MwoA and controls. Increasing VDS was associated with greater BOLD signal change in MWA ( p = 0.03) but not MwoA ( p = 0.65) or controls ( p = 0.53). MPS did not correlate with BOLD activation in either group. Conclusion Increased interictal visual sensitivity is present both in MWA and MwoA. However, the correlation with ictal visual sensitivity and with cortical hyper-responsivity varies between MWA and MwoA, suggesting underlying differences between groups.
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/0333102414547782
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 5
    Online Resource
    Online Resource
    White matter lesion burden in migraine with aura may be associated with reduced cerebral blood flow
    SAGE Publications ; 2017
    In:  Cephalalgia Vol. 37, No. 6 ( 2017-05), p. 517-524
    Details
    In: Cephalalgia, SAGE Publications, Vol. 37, No. 6 ( 2017-05), p. 517-524
    Abstract: The objective of this study was to determine whether white matter hyperintensities (WMHs) in subjects with migraine are related to alterations in resting cerebral blood flow (CBF). Methods Migraine with aura (MWA), migraine without aura (MwoA), and control subjects were enrolled in a 1:1:1 ratio. WMH load was scored based on fluid-attenuated inversion recovery/T2-weighted magnetic resonance imaging (MRI) using a previously established semi-quantitative scale. Global and regional CBFs were quantified using arterial spin labelled perfusion MRI. Integrity of the circle of Willis was assessed with magnetic resonance angiography (MRA). Results A total of 170 subjects were enrolled (54 controls, 56 MWA, and 60 MwoA). There was no significant difference in subjects with ≥1 WMH across groups (22% controls, 29% MWA, 35% MwoA; p = NS). Similarly, high WMH load was not significantly different across groups (16.7% controls, 21.4% MWA, 25.0% MwoA; p = NS). High WMH load was strongly associated with increasing age (odds ratio: 1.08 per year, 95% confidence interval: 1.02–1.13, p = 0.01). Resting CBF was similar across groups, but was significantly higher in women. In MWA subjects with high WMH load, CBF was substantially lower ( p = 0.03). No association between WMH load and CBF was seen in control or MwoA subjects. Conclusions WHMs in MWA may be related to alterations in resting CBF.
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/0333102416649760
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 6
    Online Resource
    Online Resource
    Absence of changes in cortical thickness in patients with migraine
    SAGE Publications ; 2011
    In:  Cephalalgia Vol. 31, No. 14 ( 2011-10), p. 1452-1458
    Details
    In: Cephalalgia, SAGE Publications, Vol. 31, No. 14 ( 2011-10), p. 1452-1458
    Abstract: Objective: Previous studies have reported gray matter alterations in patients with migraine, particularly thinning of the cingulate gyrus, and thickening of the somatosensory cortex (SSC) and visual motion processing areas (V3A/MT+). We attempted to replicate these findings in a larger patient population. Methods: Brain anatomy was collected with 3T MRI. Surface-based morphometry was used to segment each brain volume, reconstruct and inflate the cortical sheet, and estimate gray matter thickness. Results: Eighty-four age and sex-matched participants (28 migraine with aura, 28 migraine without aura, and 28 controls) were studied. No significant differences in somatosensory, cingulate gyrus, or V3A/MT+ cortical thickness were found between the groups, including analysis of specific subregions previously reported to be affected. Whole brain analysis found no regions of differential gray matter thickness between groups. A highly significant inverse correlation between age and whole brain and regional cortical thickness was identified. Power analyses indicate that even a small difference (∼0.07 to 0.14 mm) in cortical thickness could have been detected between groups given the sample size. Interpretation: Using highly sensitive surface-based morphometry, no differences in cortical thickness between patients with migraine and controls could be identified.
    Type of Medium: Online Resource
    ISSN: 0333-1024 , 1468-2982
    URL: Article
    DOI: 10.1177/0333102411421025
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
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  • 7
    Online Resource
    Online Resource
    Validation Assessment of Risk Scores to Predict Postthrombolysis Intracerebral Haemorrhage
    SAGE Publications ; 2011
    In:  International Journal of Stroke Vol. 6, No. 2 ( 2011-04), p. 109-111
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 6, No. 2 ( 2011-04), p. 109-111
    Abstract: Two clinical risk scores, the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores, have been proposed to predict the risk of intracerebral haemorrhage following thrombolysis in acute ischaemic stroke. Aims To validate Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores as predictors of post-tissue plasminogen activator symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage in an independent cohort. Methods Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were calculated for the cohort of tissue plasminogen activator-treated patients enrolled in the placebo arms of the SAINT-I and SAINT-II trials. The absolute risk of symptomatic intracerebral haemorrhage and asymptomatic intracerebral haemorrhage associated with each scoring system was determined. The overall predictive value was assessed using c-statistics. Results Symptomatic intracerebral haemorrhage occurred in 5·6% of 965 patients treated with tissue plasminogen activator in the SAINT cohorts. The risk of symptomatic intracerebral haemorrhage was modestly greater, with higher Haemorrhage After Thrombolysis scores (0: 4·1%, 1: 4·1%, 2: 8·8%, 3: 12·5%, 4: 0%, 5: no subjects). Similar results were seen with the Multicentre Stroke Survey score (0: 0%, 1: 4·8%, 2: 2·3%, 3: 7·3%, 4: 6·3%). In logistic regression, the Haemorrhage After Thrombolysis score was associated with the risk of symptomatic intracerebral haemorrhage (odds ratio=1·41 per point, 95% confidence interval: 1·05–1·89, P=0·021) and asymptomatic intracerebral haemorrhage (odds ratio=1·59 per point, 95% confidence interval: 1·33–1·92, P 〈 0·001). The Multicentre Stroke Survey score was modestly associated with the risk of symptomatic intracerebral haemorrhage (odds ratio=1·43 per point, 95% confidence interval: 0·95–2·15, P=0·084) and asymptomatic intracerebral haemorrhage (odds ratio=1·63 per point, 95% confidence interval: 1·27–2·08, P 〈 0·001). The c-statistic was 0·59 for predicting symptomatic intracerebral haemorrhage and 0·61 for asymptomatic intracerebral haemorrhage for both the Haemorrhage After Thrombolysis and the Multicentre Stroke Survey scores. Conclusions While both the Haemorrhage After Thrombolysis and Multicentre Stroke Survey scores were associated with a risk of symptomatic intracerebral haemorrhage, discriminatory ability was limited.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1111/j.1747-4949.2010.00556.x
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2211666-7
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  • 8
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    Online Resource
    Computed tomography perfusion in stroke mimics
    SAGE Publications ; 2020
    In:  International Journal of Stroke Vol. 15, No. 3 ( 2020-04), p. 299-307
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 15, No. 3 ( 2020-04), p. 299-307
    Abstract: To describe the prevalence and patterns of abnormal findings on automated computed tomography perfusion in patients with stroke mimic. Methods We reviewed a retrospective multi-site cohort of consecutive patients undergoing computed tomography perfusion for suspected acute ischemic stroke within 24 h from last normal (June 2017 to December 2017). The primary outcome was the diagnosis of stroke mimic. Hypoperfusion abnormalities on iSchemaView RAPID automated computed tomography perfusion were compared between patients with stroke/transient ischemic attack and stroke mimic using mixed-effects multivariable logistic regression, focusing on absence of perfusion abnormalities and discordance with clinical symptoms and computed tomography angiography findings. Results Of 410 consecutive patients who underwent computed tomography perfusion, 348 met inclusion criteria (178 (51%) stroke, 19 (6%) transient ischemic attack, and 151 (43%) mimic). Time-to-maximum of the tissue residue function (T max 〉 6s) abnormalities were seen in 42 (28%) patients with stroke mimic and 122 (62%) patients with stroke/transient ischemic attack ( p  〈  0.001). Patients with stroke mimic were more likely to have a normal T max pattern (volume = 0mL; adjusted OR: 2.2, 95% CI: 1.1–4.3, p = 0.02). When the T max pattern was abnormal, a higher proportion of patients with stroke mimic had T max patterns fully discordant with clinical symptoms than patients with stroke/transient ischemic attack (28/39 (71%) vs. 10/115 (9%), p  〈  0.001). Fully discordant T max abnormalities were strongly associated with stroke mimic (adjusted OR: 48.6, 95% CI: 7.0–336, p  〈  0.001), with a negative predictive value for identifying mimic of 91% (95% CI: 85–94%). Conclusion While one-quarter of patients with stroke mimic show T max abnormalities on automated RAPID computed tomography perfusion imaging, the majority of patterns were discordant with symptoms and vessel status. Normal or fully discordant T max abnormalities are were more common with stroke mimic and may inform stroke treatment decision making.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493019869702
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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