Association between migraine and aura, migrainous infarction and cortical laminar necrosis: a literature review/ Associação entre enxaqueca e aura, enxaqueca por enfarte e necrose laminar cortical: uma revisão bibliográfica

Abstract

Introduction: Migraine infarction is one of the rare complications of migraine with aura, characterized by the persistence of aura symptoms for more than sixty minutes, associated with ischemic brain damage in the appropriate territory, demonstrated by neuroimaging examination. In spite of several cases reported in the literature correlate cerebral infarction with migraine, it is still unclear which magnetic resonance (MRI) pattern is associated with this condition. Cortical laminar necrosis (CLN) is a type of cortical infarction characterized by selective and late necrosis, especially in the third layer of the cerebral cortex, a region where there is greater vulnerability to metabolic stress. On MRI, CLN is characterized by an increase in cortical signal intensity on T1-weighted images with a typical curvaceous gyriform distribution. The goal of this study was to demonstrate, throughout a literature review, a possible association between migraine with aura, migraine infarction and cortical laminar necrosis without neuroimaging examination.Methods: A systematic research was performed in databases at the PubMed and Embase in February 2021. The search terms used for 'Migraine' or 'Migraine with aura' or 'Migrainous Infarction' combined with 'Cortical Laminar Necrosis', using their respective variations of the according as MeSH and Emtree. It was articles published in English, in pair reviewed journals, during any period and submitted to studies relevant to clinical questions, which revealed cases of Laminar Cortical Necrosis associated with migraine, were included. Studies that do not attempt the criteria, was excluded.Results and Discussion: The search for selected databases resulted in 24 articles. Excluding 14 articles were not chosen because they are not CLN, and 1 article published in conference abstracts that we did not choose for this review. Finally, 8 original studies were selected and critically analyzed in this review. There was a prevalence in hundred percent of the cases analyzed with migraine with aura (Table 1), and all of them manifested additional neurological symptoms. In two cases, the etiology was of familiar legacy of genetic origin, which consisted of a familial hemiplegic migraine. MR was performed days after the begining of symptoms, ranging from the 3rd to the 30th day. In all cases, was observed unilateral cortical hypersignal on axial T1-evaluation. Unilateral T1-evaluation cortical hyperintensity with Gadoliun and FLAIR was also identified in most of the cases. Less commonly, alterations to the DWI and ADC sequences are seen. Conclusion: Despite being a rare manifestation, this review demonstrates that CLN can be recognized as an attribute associated with migraine with aura, spread the spectrum of neuroimaging acts correlated with migraine. Our goal was narrow the boundaries between neurovascular disease on imaging and a migraine with aura, helping neurologists to recognize this association. Before this scene of high predominance of migraines, further studies are needed to elucidate its relationship with CLN, as its pathophysiology and group of patients with risk factors, who may benefit from prophylactic treatment.