Related Experiment Video
Updated: Jan 28, 2026
Investigating Migraine-Like Behavior Using Light Aversion in Mice
Published on: August 11, 2021
How much do periventricular lesions assist in distinguishing migraine with aura from CIS?
Caterina Lapucci1, Laura Saitta2, Giulia Bommarito2
1From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (C.L., G.B., M.P., L.B., G.L.M., M.I.), University of Genoa; Departments of Neuroradiology (L.S., L.R.), Health Sciences (M.P.S., L.R.), and Neurology (M.P., G.L.M., M.I.), Ospedale Policlinico San Martino IRCCS, Genoa; Department of Neurosciences (C.G.), S. Camillo-Forlanini Hospital, Rome; and Departments of Medicine, Surgery, and Neuroscience (A.G., N.D.S.), University of Siena, Italy. lapuccicate@gmail.com.
Objective:
To evaluate in clinically isolated syndrome (CIS) and migraine with aura (MA) how the number of periventricular lesions (PVLs) detected at MRI influences diagnostic performance when the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) or the 2017 revised criteria are applied.
Methods:
In this retrospective study, white matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Furthermore, we performed a logistic regression analysis based on lesion locations and volumes.
Results:
Compared to patients with MA, patients with CIS showed a significant overall higher 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 < 0.0001) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas (p < 0.0001). LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS. Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs. MAGNIMS criteria demonstrated the highest specificity in differentiating patients with CIS from patients with MA (100% vs 87%) against a predictable lower sensitivity (63% vs 72%).
Conclusions:
PVLs play a key role in the differential diagnosis between MA and CIS, particularly when there are more than 3. Future studies on multiple sclerosis criteria might reconsider the 3 PVLs to minimize the risk of misdiagnosis.
Classification Of Evidence:
This study provides Class IV evidence that the presence at least 3 PVLs increases the specificity in distinguishing MA from CIS.
Insights
Periventricular lesions (PVLs) on MRI are key for differentiating clinically isolated syndrome (CIS) from migraine with aura (MA). Having more than 3 PVLs significantly increases diagnostic specificity, reducing misdiagnosis risk.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Differentiating clinically isolated syndrome (CIS) from migraine with aura (MA) is crucial for accurate diagnosis and management.
- Magnetic Resonance Imaging (MRI) plays a vital role in identifying white matter hyperintensities (WMH), which can be present in both conditions.
- The Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) criteria and revised 2017 criteria aim to aid in this differentiation.
Purpose of the Study:
- To evaluate how the number of periventricular lesions (PVLs) detected on MRI influences the diagnostic performance of the MAGNIMS and 2017 revised criteria in distinguishing CIS from MA.
- To investigate the specific role of PVLs in the differential diagnosis between CIS and MA.
Main Methods:
- Retrospective analysis of MRI data from 84 patients with MA and 79 patients with CIS.
- Manual segmentation of white matter hyperintensities (WMH) and creation of lesion probability maps (LPMs).
- Voxel-wise analysis of lesion distribution and logistic regression based on lesion location and volume.
Main Results:
- Patients with CIS exhibited significantly higher T2 WMH mean number and volume compared to patients with MA.
- Periventricular regions showed the highest probability of detecting T2 WMH in patients with CIS, as identified by LPMs.
- A statistically significant association was found exclusively between the diagnosis of CIS and PVLs. MAGNIMS criteria showed higher specificity (100%) in differentiating CIS from MA compared to the 2017 criteria (87%).
Conclusions:
- Periventricular lesions (PVLs) are critical in the differential diagnosis between MA and CIS, especially when exceeding 3 lesions.
- The findings suggest that future multiple sclerosis diagnostic criteria might benefit from reconsidering the threshold of 3 PVLs to minimize misdiagnosis.
- The presence of at least 3 PVLs significantly enhances the specificity of distinguishing MA from CIS.
Related Concept Videos
02:02Cis-regulatory Sequences
02:02Cis-regulatory Sequences
02:37Disubstituted Cyclohexanes: cis-trans Isomerism
In cyclohexane, the substituents can occupy different positions generating distinct isomers....
02:24Reduction of Alkynes to cis-Alkenes: Catalytic Hydrogenation
Like alkenes, alkynes can be reduced to alkanes in the presence of transition metal catalysts such as Pt, Pd, or Ni. The reaction involves two sequential syn additions of hydrogen via a cis-alkene intermediate.
01:08Matrix-Assisted Laser Desorption Ionization (MALDI)
02:52Stereoisomerism
Isomers are different chemical species that have the same chemical formula.
Transition metal complexes often exist as geometric isomers, in which the same atoms are connected through the same types of bonds but with differences in their orientation in space. Coordination complexes with two different ligands in the cis and trans positions from a ligand of interest form isomers. For example, the octahedral [Co(NH3)4Cl2]+ ion has two isomers (Figure 1) In the cis...