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Right‐to‐left shunt, right aortic arch and aberrant left subclavian artery presenting with thoracic outlet syndrome (TOS) and migraine: MRI, MRA, MRV and Transcranial Doppler (TCD)
Author(s) -
Saxton Ernestina H.,
Collins James D.,
Ahn Samuel S.,
Gelabert Hugh,
Carnes Alfred
Publication year - 2009
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.23.1_supplement.474.6
Subject(s) - medicine , patent foramen ovale , migraine , migraine with aura , transcranial doppler , aortic arch , cardiology , right to left shunt , stroke (engine) , aura , radiology , aorta , mechanical engineering , engineering
Patients with thoracic outlet syndrome have severe migraine with or without aura. There is an increased prevalence of right‐to‐left shunt, mainly patent foramen ovale (PFO) in migraineurs with aura and an increased prevalence of migraine in patients with PFO. Atrial septal defects may occur as well. Studies indicate that migraine is a relative risk factor for stroke. Cerebral embolism rarely may occur as a complication of TOS. A possible mechanism of stroke in both migraine and TOS may be passage of microemboli or toxic substances. Over 500 patients have presented with symptoms of migraine and a clinical diagnosis of TOS. We have also evaluated over 100 to assess cerebral blood flow and microembolic signals. Monitored multiplanar images with abduction external rotation and 2D Time of Flight MRA/MRV without contrast were acquired on a 1.5 Tesla GE Signa LX unit, 44 cm field of view, 521 x 256 matrix and saline water bags to enhance signal to noise ratio. A Portable Nicolet/Viasys Companion III Transcranial Doppler Unit with a 2MHZ transducer was used to interrogate the arterial system of the Circle of Willis. We present two patients with severe migraine and TOS who were found to have right aortic arch and aberrant left subclavian artery (Type II) on MRI/MRA/MRV and right to left shunt on transcranial Doppler (TCD). Neither patient has experienced an ischemic event and is treated with aspirin for primary prevention of stroke.