Migraine and patent foramen ovale: transesophageal echocardiography study. should we exclude migraine without aura?

The prevalence and size of patent foramen ovale [PFO] in migraine without aura have never been assessed directly using Transesophageal echocardiography [TEE] and compared with migraine with aura. We sought to assess the prevalence and the size of patent foramen ovale in patients suffering from migraine with [MA] and without [MoA] aura using TEE. consecutive patients with migraine with and without aura were asked to participate in the study. Impact of migraine on daily life was assessed using the Migraine Disability Assessment [MIDAS] questionnaire. Contrast transesophageal echocardiography was performed to all participants and the presence of a patent foramen ovale and their size were assessed. forty consecutive patients with migraine headache were included in our study. The majority of participants were women, mean age was 26.7 [18-38 year]. Family history of migraine was encountered in 65% of patients. The mean Migraine severity using MIDAS was 16.2 [5-28] half of the patients were higher than the score of 21. Out of the 40 studied patients, 18 [45%] showed patent foramen ovale in TEE examination. Twenty patients [50%] had migraine with aura. There was no statistical difference between MA and MoA patients regarding age, sex, and MIDAS. The prevalence of patent foramen ovale was significantly higher in MA patients 11 out of 20 [55%] compared with 7 out of 20 [35%] MoA patients [OR 2.7, p = 0.005]. The presence of PFO was significantly related to the migraine disability severity score. Large PFO size was found in 45% of patients with MA while 42% of patients with MoA [p = NS]. although prevalence of PFO is higher in migraine with aura, the prevalence of large PFO is nearly the same in both subtypes of migraine and more related to severity of migraine disability and family history of migraine

Predictive and clinical value of cerebral microemboli detection in cardnic patients

Cardioembolic strokes have a worse prognosis and produce larger and more disabling strokes than other ischemic stroke subtypes. We sought to evaluate the prevalence of High-intensity-transient-signals [HITS] in patients having different cardiac sources of emboli and the value of transcranial Doppler [TCD] in stroke prediction. consecutive cardiac patients were subjected to ECG, transthoracic echocardiography, and TCD examination. a total of 45 cardiac patients were investigated; twenty patients with rheumatic heart disease, 10 with prosthetic valves, and 15 with myocardial ischemia. In all patients, the presence of HITS was not affected by the patients' age, gender, the presence of risk factors, the platelet count or the INR level. Cerebral strokes were significantly higher in patients with HITS than those without. In patients with prosthetic heart valves, 60% was HITS-positive with a mean rate of 14.2 +/- 6.49/ 30 minutes, which was significantly higher than myocardial ischemia and rheumatic heart disease patients. In myocardial ischemia group, a higher prevalence of HITS was found with left ventricular ejection fraction [LVEF] < 55% and left ventricular thrombus.In rheumatic heart and ischemic heart disease groups > 80% of patients treated with antithrombotics and/or thrombolytics did not show any HITS, while in mechanical heart valves only 20% of patients received anticoagulants plus aspirin was HITS-negative. Cerebral strokes are significantly higher in cardiac patients with detected HITS than those without. In patients with prosthetic heart valves, anticoagulants didn 't significantly decrease or clear HITS