ABSTRACT NUMBER: ESOC2026A436 DISRUPTION OF THE BLOOD BRAIN BARRIER IN PATIENTS EXPERIENCING MIGRAINE AURA

Abstract Background and aims Cortical spreading depression (CSD) is believed to occur during migraine with aura (MwA). Animal models of CSD show blood brain barrier disruption (BBBD) however this has not been demonstrated in humans. Methods This is a post-hoc analysis of a cohort of 60 patients presenting with stroke-like symptoms that were DWI-negative for stroke on MRI (MARIE study cohort). MRIs were performed during or within 2 hours of aura and included a dynamic susceptibility contrast (DSC) sequence. Gadolinium leakage on DSC source images was used to generate BBB heatmaps. Patients were classified as MwA (by International Headache Society (IHS) criteria or if MwA was the final diagnosis), TIA, psychogenic or undetermined. The pattern of BBBD was classified by consensus of two neurologists blinded to the diagnosis into four types: (1) extensive, (2) diffuse, (3) minimal, or (4) absent. The figure shows examples of each type. Results 58 patients had adequate imaging quality to do the BBB analysis and were included. The median age was 39.5, 74% were women. Diagnoses were MwA in 42 (36 meeting IHS criteria), TIA in 2, psychogenic in 8 and undetermined in 6. Of the MwA patients, 7 had type1 BBBD, 8 had type2 BBBD, 13 had type3 BBBD and 10 had no evidence of BBBD (type4). There were 2 patients classified as psychogenic who demonstrated type1 and type2 and one classified as undetermined who demonstrated type2. Conclusions About one-third of MwA patients demonstrated BBBD when imaged during or within two hours after aura resolution however pattern and severity varied widely. Conflict of interest Richard Leigh: nothing to disclose; Olivot Jean-Marc: nothing to disclose; Adam Gilles: nothing to disclose; Albucher Jean-Francois: nothing to disclose; Calvière Lionel: nothing to disclose; Fontaine Louis: nothing to disclose; Raposo Nicolas: nothing to disclose; Thalamas Claire: nothing to disclose; Bonneville Fabrice: nothing to disclose; Viguier Alain: nothing to disclose; Figure 1 - belongs to Conclusions