Author + information
- Received October 4, 2011
- Revision received February 23, 2012
- Accepted March 16, 2012
- Published online June 1, 2012.
- Hamidreza Khessali, MD⁎,
- M. Khalid Mojadidi, MD⁎,
- Rubine Gevorgyan, MD⁎,
- Ralph Levinson, MD† and
- Jonathan Tobis, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jonathan Tobis, Department of Medicine, UCLA Medical Center, B976 Factor Building CHS, 10833 Le Conte Avenue, Los Angeles, California 90095
Objectives The aim of this study was to assess the prevalence of right-to-left (R to L) shunt in patients with visual aura and evaluate the effect of shunt closure on resolution of aura.
Background Right-to-left shunting is associated with migraine headache (MH) with aura. Some patients present with visual aura without headaches. It is unclear whether visual aura without headache is a form of migraine or a transient neurologic dysfunction.
Methods Of patients referred to the University of California, Los Angeles for suspected patent foramen ovale (PFO), 225 had visual aura with or without MH. Patients were assessed for a shunt and evaluated for MH and/or visual aura. They were divided into 3 groups: 1) visual aura associated with MH; 2) visual aura unrelated in time to MH; and 3) visual aura without MH. The frequency of R to L shunt was compared with a control group of 200 patients. Eighty patients underwent PFO closure. Residual shunts, MH, and visual aura were reassessed after 3 and 12 months.
Results The prevalence of R to L shunt in Groups A, B, and C was 96%, 72%, and 67%, respectively, versus 18% in the control group (p < 0.0001). The frequency of shunting was similar in Group B versus Group C, but much higher in all 3 groups compared with control subjects. Twelve months after PFO closure, symptoms of aura were resolved in 52%, 75%, and 80% of patients in Groups A, B, and C, respectively (p = NS).
Conclusions The similar distribution of R to L shunting in all 3 patient groups and the correlation between PFO closure and improvement of aura suggests a similar pathophysiology between the presence of PFO and the visual aura phenomenon, whether or not headache is present in the symptom complex.
Dr. Levinson has received support from the McDonald Foundation and the Research to Prevent Blindness Fund. AGA Medical, Inc., provided the transcranial Doppler system and an unrestricted grant to support this research; Dr. Tobis is a consultant for AGA Medical, Inc., W.L. Gore, Inc., and Coherex, Inc. and he is on the steering committee for PREMIUM Trial, AGA Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 4, 2011.
- Revision received February 23, 2012.
- Accepted March 16, 2012.
- American College of Cardiology Foundation