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Livedo reticularis and migraine: a marker for stroke risk?
[sneddon syndrome]
Livedo
reticularis
is
a
dermatopathy
characterized
by
an
irregular
,
violaceous
,
netlike
pattern
which
spares
the
face
.
Associated
with
a
variety
of
conditions
,
it
occurs
consequent
to
pathological
or
physiological
narrowing
of
small
and
medium
arteries
at
the
dermis-subcutis
border
.
Sneddon
syndrome
refers
to
the
idiopathic
coupling
of
livedo
reticularis
and
stroke
in
the
absence
of
traditional
vascular
risk
factors
.
Over
50
%
of
persons
with
Sneddon
syndrome
describe
a
history
of
headache
.
We
undertook
this
study
to
determine
the
frequency
of
livedo
reticularis
in
our
headache
clinic
.
We
performed
a
retrospective
chart
review
of
consecutive
patients
attending
a
headache
clinic
over
a
period
of
6
months
.
The
patients
had
all
been
seen
by
one
physician
(
G
.
E
.
T
.
)
who
noted
the
presence
or
absence
of
livedo
reticularis
.
The
charts
were
reviewed
for
age
,
sex
,
and
vascular
risk
factors
,
including
current
use
of
oral
contraceptives
,
and
history
of
smoking
,
coronary
artery
disease
,
hypertension
,
diabetes
mellitus
,
stroke
,
or
arthritis
.
Charts
from
133
patients
with
headache
were
reviewed
(
24
men
[
18
%
]
,
109
women
[
82
%
]
;
mean
age
,
42
+
/
-
13
years
)
.
Livedo
reticularis
was
observed
in
29
patients
(
22
%
)
and
in
a
similar
proportion
in
men
(
25
%
)
and
women
(
21
%
)
.
When
we
stratified
the
migraine
population
by
presence
or
absence
of
livedo
,
we
found
no
significant
difference
in
age
(
44
.
5
versus
41
.
7
years
,
P
=
.
16
)
.
There
was
a
higher
frequency
of
stroke
diagnosis
in
the
cohort
with
livedo
reticularis
(
28
%
[
8
of
29
]
versus
7
%
[
7
of
104
]
,
P
=
.
005
)
,
but
we
found
no
significant
differences
in
frequency
of
hypertension
,
oral
contraceptive
use
,
diabetes
mellitus
,
coronary
artery
disease
,
arthritis
,
or
cigarette
smoking
.
In
our
headache
clinic
,
livedo
reticularis
is
present
in
more
than
one
fifth
of
patients
.
A
history
of
stroke
is
more
frequent
in
this
subset
of
migraineurs
,
raising
the
possibility
that
livedo
reticularis
can
be
used
as
a
clinical
marker
to
identify
those
migraineurs
with
an
increased
risk
of
stroke
.
Diseases
Validation
Diseases presenting
"arthritis"
symptom
acute rheumatic fever
child syndrome
congenital adrenal hyperplasia
cystinuria
familial hypocalciuric hypercalcemia
familial mediterranean fever
focal myositis
harlequin ichthyosis
homocystinuria without methylmalonic aciduria
inclusion body myositis
lamellar ichthyosis
malignant atrophic papulosis
pyomyositis
sneddon syndrome
trochlear dysplasia
typhoid
wiskott-aldrich syndrome
This symptom has already been validated