Hemorrhagic stroke as a rare complication of a migraine without aura

Background

Migraine is a chronic neurological disorder, characterized by recurrent headache attacks featuring specific clinical characteristics. Two-thirds of the migraineurs are women. It takes the second place among the world’s causes of disability, and is one of the leading causes for direct and indirect government expenses. Migraine is well known to be associated with cerebrovascular diseases, in particular with stroke. Due to the recent studies, the risk of hemorrhagic stroke (HS) is 50% higher in between migraineurs in comparison to non-migraineurs, whereas only one study showed association of migraine without aura (MwtA) with increased HS incidence.

Case presentation

We present a case of 57-year-old White woman, who is a 20-year migraine sufferer admitted to the hospital with the signs of migraineous stroke. Upon evaluation after she had contrast enhancing brain magnetic resonance imaging (MRI), she was diagnosed with a neoplasm accompanied by a hemorrhage. However, the following magnetic resonance spectroscopy (MRS) as well as repeated contrast MRI did not prove the diagnosis. The patient was treated for 10 days, and discharged with complete clinical improvement.

Conclusion

The presented case highlights the importance of the accurate evaluation of the patients, suspicious of complicated migraine, even though suffering from MwtA, having no comorbidities and absent family history of cerebrovascular diseases.

Meta-analysis of associations of genetic polymorphisms with cerebral vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

INTRODUCTION

Cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) are among the most hazardous complications of aneurysmal subarachnoid hemorrhage (aSAH). Genetic factors are thought to play a significant role in the development of both complications.

AIM

To perform a comprehensive meta-analysis of studies that study the association between different genetic polymorphisms and development of DCI and/or CV.

METHODS

We searched MEDLINE and Science Direct databases on May 29, 2021, using iterations of the keywords "subarachnoid hemorrhage", "vasospasm", "delayed cerebral ischemia", and "gene". After duplicates were removed, the two reviewers screened the titles of the articles and abstracts independently. A random-effect model was used to calculate the relative risk with 95% CI; a fixed-effect model was additionally explored.

RESULTS

We pooled data from 16 articles that reported an association between eNOS, apolipoprotein E4 (ApoE4), haptoglobin (Hp), or ryanodine-1 (RYR-1) and CV, DCI, or both. Presence of Hp 2-2 was associated both with CV (RR 2.10, 95% CI 1.33-3.31, p = 0.0014) and DCI (RR 1.57, 95%CI 1.06-2.34, p = 0.026). ApoE4 allele had a borderline association with CV (RR 1.48, 95%CI 0.99-2.21, p = 0.054).

CONCLUSION

Our meta-analysis supports the association between the presence of the Hp2-2 allele and the occurrence of CV and DCI after aSAH. Further studies investigating this association are needed to reinforce this finding.