Periventricular lesions (PVLs) detected with magnetic resonance imaging play an important role in the differential diagnosis between migraine with aura and clinically isolated syndrome, especially when more than 3 PVLs are present, according to results published in Neurology.

The study included participants with migraine with aura (n=84) and participants with clinically isolated syndrome (n=79). The researchers used manual segmentation technique to assess white matter hyperintensities (WMH). They obtained lesion probability maps and voxel-wise analysis of lesion distribution by diagnosis. The researchers then performed logistic regression analysis based on lesion locations and volumes.

Compared with participants with migraine with aura, those with clinically isolated syndrome had a significantly higher overall T2 WMH mean number and volume (17.9±16.9 vs 6.2±11.9 and 3.1±4.2 vs 0.3±0.6 mL; P <.0001). Participants with clinically isolated syndrome also had significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas compared with those with migraine with aura (P <.0001).

For participants with clinically isolated syndrome, the researchers found that lesion probability maps identified the periventricular regions as the sites with the highest likelihood of detecting T2 WMH.

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After performing voxel-wise analysis of lesion distribution by diagnosis, the researchers found a statistically significant association between the diagnosis of clinically isolated syndrome and PVLs. There was an 85% decrease in the probability for the diagnosis to be migraine with aura for each additional PVL over the first lesion.

“The appropriateness of increasing the number of PVLs from 1 to 3 could be reconsidered in future revisions of diagnostic criteria to reduce the risk of misdiagnosis,” the researchers wrote.

Disclosures: Several researchers report the receipt of consulting fees

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Reference

Lapucci C, Saitta L, Bommarito G, et al. How much do periventricular lesions assist in distinguishing migraine with aura from CIS? [published online March 8, 2019]. Neurology. doi:10.1212/WNL.0000000000007266.

This article originally appeared on Neurology Advisor