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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
"headache"
symptom
acute rheumatic fever
adrenal incidentaloma
allergic bronchopulmonary aspergillosis
cadasil
cushing syndrome
cutaneous mastocytosis
erdheim-chester disease
esophageal squamous cell carcinoma
familial mediterranean fever
hereditary cerebral hemorrhage with amyloidosis
hydrocephalus with stenosis of the aqueduct of sylvius
legionellosis
locked-in syndrome
malignant atrophic papulosis
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
typhoid
von hippel-lindau disease
This symptom has already been validated