Cerebral Blood Flow and Volume in Symptom-Free Migraineurs: a SPECT Study

Both CBF and CBV were evaluated by gamma-camera SPECT in 14 patients with classic migraine, all studied while symptom-free. Nuclear data were correlated with CT and MRI. A decreased regional CBF was observed in 13 of the 14 patients. The decreased perfusion was localized in the frontal lobe in 6 patients, the temporal lobe in one, the parietal lobe in 11 and the occipital lobe in 5 patients. The parieto-occipital cortex was involved more often than the frontal cortex; the association of hypoperfusion with parieto-occipital cortex was quite high. The right parieto-occipital regions were affected more often than the left ones. Regional CBV was increased in 8 patients. There was good topographical concordance between decreased CBF and increased CBV, but the increase of CBV was in general more evident at the periphery of the hypoperfusion. It is of interest that the only patient with a normal CBF study had a pathological CBV study. Apparently, CBF derangements are very common in symptom-free patients with classic migraine, a CBF decrease being often accompanied by a CBV increase. In these patients both CT and MRI have a lower diagnostic yield than SPECT.

Zusammenfassung

Die CBF- und CBV-SPECT (rotierende Gammakamera) wurde bei 14 Patienten mit klassischer Migräne eingesetzt. Alle Patienten wurden im symptomfreien Intervall untersucht und die Ergebnisse mit CT und KST korreliert. Bei 13 dieser Patienten wurde eine verminderte regionale Hirndurchblutung beobachtet. Diese war bei 6 Patienten frontal, bei einem temporal, bei 11 parietal und bei 5 Patienten okzipital lokalisiert. Der parieto-okzipitale Kortex war signifikant häufiger beteiligt als der frontale Kortex. Die Verknüpfung einer Hypoperfusion mit dem parieto-okzipitalen Kortex war statistisch zu sichern. Die rechte parieto-okzipitale Region war häufiger betroffen als die linke. Das regionale Blutvolumen war bei 8 Patienten erhöht. Es ergab sich eine gute topographische Übereinstimmung von vermindertem Fluß und Erhöhung des Volumens, die häufiger in der Peripherie der Hypoperfusion zu finden war. Der einzige Patient mit normaler Hirndurchblutung hatte ein erhöhtes Volumen. Offenbar sind bei symptomfreien Patienten mit klassischer Migräne Störungen der regionalen Hirndurchblutung relativ häufig, wobei eine Verminderung der Hirndurchblutung häufig von einer Erhöhung des Blutvolumens begleitet ist. Bei diesen Patienten war der diagnostische Beitrag von CT und KST geringer als jener der SPECT.

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