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Anatomical Variants of the Circle of Willis and Brain Lesions in Migraineurs

Published online by Cambridge University Press:  02 December 2014

C. Cavestro ,
L. Richetta ,
M. R. L'Episcopo ,
E. Pedemonte ,
S. Duca  and
C. Di Pietrantonj
C. Cavestro*
Affiliation:
Department of Neurology, San Lazzaro Hospital, Alba
L. Richetta
Affiliation:
Department of Neuroradiology, Maggiore Santissima Trinità Hospital, Fossano, CN
M. R. L'Episcopo
Affiliation:
Department of Neurology, San Lazzaro Hospital, Alba
E. Pedemonte
Affiliation:
Department of Neurology, San Lazzaro Hospital, Alba
S. Duca
Affiliation:
Department of Neuroradiology, Koelliker Hospital, Turin
C. Di Pietrantonj
Affiliation:
Regional Epidemiology Service, Servizio Regionale Epidemiologia (SeREMI), ASL AL Alessandria, Italy
*
Headache Center, Department of Neurology, San Lazzaro Hospital, A.S.L. CN2, Alba (CN), Italy. E-mail: [email protected].
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Abstract

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Background:

Some reports demonstrated vascular alterations in brain magnetic resonance imaging (MRI) in migraineurs and a relationship between circle of Willis (Circle) variants and lacunar brain infarcts. We examined anomalies of the whole circle of Willis and their relationship with vascular brain lesions in migraineurs, to identify any possible vascular mechanism in migraine.

Methods:

We studied, with a cohort controlled study, the circle of Willis in migraineurs seen consecutively in our Headache Center, and in non-headache controls, using angio-MRI of the brain. Statistical analysis used ANOVA, Scheffè's criterion, t-student test.

Results:

We recruited 270 migraineurs (204 without aura (MWOA), 66 with aura (MWA) and 159 controls. Migraineurs presented an anatomical variant in 108 (40%) cases with 34 controls (21.4%) presenting a variant. We found a significant association between MWOA and variants (OR=2.4 CI95% [1.5 to 3.9]) and between MWA and variants (OR=3.2 CI95% [1.6 to 4.1]). Unilateral posterior variants with basilar hypoplasia are statistically associated only with MWA compared to controls (OR=9.2, CI95% [2.3 to 37.2]). Thirty-three percent of MWOA and 24% of MWA sufferers present some kind of brain lesion, included 2% of infra-tentorial lesions. We did not find any statistical association between the presence of Circle variants and ischemic lesions on MRI (OR=1.5 CI95% [0.68; 1.94]), or with infratentorial lacunar lesions (OR=1.58 CI95% [0.48 to 5.24]).

Conclusions:

Anatomical variants of the Circle of Willis are significantly more frequent in migraineurs; posterior anomalies are more frequent in MWA, suggesting a vascular mechanism provoking changes in cerebral blood flow, thereby stimulating cortical spreading depression.

Résumé:

Résumé:Contexte:

Certaines publications font état d’altérations vasculaires à l’IRM du cerveau chez les migraineux et d’une relation entre des variantes de l’hexagone de Willis et les infarctus cérébraux lacunaires. Nous avons examiné les anomalies de tout l’hexagone de Willis et leur relation aux lésions vasculaires du cerveau chez des migraineux afin d’identifier un mécanisme vasculaire possible dans la migraine.

Méthode:

Nous avons effectué une étude de cohorte contrôlée chez des patients migraineux, ayant consulté de façon consécutive à notre clinique de céphalée, et chez des témoins non migraineux pour étudier l’hexagone de Willis par angio IRM cérébrale. Les données ont été analysées par les méthodes statistiques suivantes : l’ANOVA, le critère de Scheffe et le test t de Student.

Résultats:

Nous avons recruté 270 patients migraineux, soit 204 sans aura (MSA) et 66 avec aura (MAA), et 159 témoins. Cent huit migraineux (40%) et 34 témoins (21,4%) étaient porteurs d’une variante anatomique. Nous avons constaté une association significative entre la MSA et les variantes anatomiques (RR = 2,4 ; IC à 95% 1,5 à 3,9) et entre la MAA et les variantes anatomiques (RR = 3,2 ; IC à 95% 1,6 à 4,1). Les variantes postérieures unilatérales avec hypoplasie basilaire sont associées statistiquement avec la MAA seulement par rapport aux témoins (RR = 9,2 ; IC à 95% 2,3 à 37,2). Trente-trois pour cent des patients atteints de MSA et 24% de ceux atteints de MAA ont une lésion au cerveau, dont 2% de lésions sous-tensorielles. Nous n’avons pas constaté d’association statistique entre la présence de variantes de l’hexagone de Willis et la présence de lésions ischémiques à l’IRM (RR = 1,5 ; IC à 95% 0,68 à 1,94) ou de lésions lacunaires sous-tensorielles (RR = 1,58 ; IC à 95% 0,48 à 5,24).

Conclusions:

Les variantes anatomiques de l’hexagone de Willis sont significativement plus fréquentes chez les patients migraineux. Les anomalies postérieures sont plus fréquentes dans la MAA, ce qui est en faveur d’un mécanisme vasculaire provoquant des changements dans le flux sanguin cérébral, stimulant ainsi une dépression se propageant au cortex.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 494 - 499
Copyright
Copyright © The Canadian Journal of Neurological 2011

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