Multiple Sclerosis Centre, II Division of Neurology, Department of Surgical Medical Science, Neurological, Metabolic and Aging, Interuniversity Center for research in Neurosciences, University of Campania L. Vanvitelli, Naples, Italy.
Department of Surgical Medical Sciences, Neurological, Metabolic and Aging, University of Campania L.Vanvitelli, Naples, Italy.
J Neurol Sci. 2018 Jul 15;390:222-226. doi: 10.1016/j.jns.2018.04.042. Epub 2018 Apr 30.
To investigate a possible association between isolated white matter lesions suggestive of demyelinating disease in magnetic resonance imaging (MRI) and patent foramen ovale (PFO) evidence in migraine patients, with or without aura.
31 migraine patients, 28 females and 3 males, with MRI evidence of white matter lesions suggestive of demyelinating disease according to the Barkhof Criteria. All patients underwent further diagnostics including lumbar puncture, autoimmunity panel and cardiological evaluation to detect the presence of PFO. The mean duration of follow-up was 3.46 years and MIPAV software was used to analyze MRI imaging.
14 of the 31 patients (45%) had PFO. A significant association was found between PFO and migraine with visual aura (p < 0.001). No difference in lesion number, volume or area between patients with and without PFO was found, but the distribution was mainly occipital (p < 0.001) in patients with PFO. The follow-up showed a stationary lesion load in all PFO patients; no infratentorial or spinal cord lesion and no enhancement or corpus callosum lesion was ever detected. At the end of follow-up four patients developed multiple sclerosis: younger age at first MRI and oligoclonal bands were associated risk factors.
Migraine is often one of the main symptoms leading to MRI, and in many cases white matter lesions of unspecific significance are discovered, thus placing demyelinating diseases in the differential diagnosis. Our study underlines the potential pathogenetic role of PFO in generating white matter lesions in migraine patients (45%), particularly those with visual aura and occipital lesions. For this reason, we affirm that PFO represents a cardinal point in the differential diagnosis of suspected demyelinating disease.
研究磁共振成像（MRI）中孤立的脑白质病变（提示脱髓鞘疾病）与偏头痛患者卵圆孔未闭（PFO）证据之间的可能关联，无论是否伴有先兆。
31 例偏头痛患者，28 例女性，3 例男性，MRI 显示有脑白质病变（提示脱髓鞘疾病），符合 Barkhof 标准。所有患者均接受进一步诊断，包括腰椎穿刺、自身免疫组和心脏评估，以检测 PFO 的存在。平均随访时间为 3.46 年，使用 MIPAV 软件分析 MRI 图像。
31 例患者中有 14 例（45%）有 PFO。发现 PFO 与偏头痛伴视觉先兆之间存在显著关联（p<0.001）。未发现 PFO 患者与无 PFO 患者的病变数量、体积或面积存在差异，但 PFO 患者的病变分布主要为枕叶（p<0.001）。随访显示所有 PFO 患者的病变负荷稳定；从未发现幕下或脊髓病变、增强或胼胝体病变。随访结束时有 4 例患者发展为多发性硬化症：首次 MRI 时年龄较小和寡克隆带与发病风险增加相关。
偏头痛通常是导致 MRI 的主要症状之一，在许多情况下，会发现无特异性意义的脑白质病变，从而将脱髓鞘疾病纳入鉴别诊断。我们的研究强调了 PFO 在偏头痛患者（45%）产生脑白质病变中的潜在发病机制，特别是那些有视觉先兆和枕叶病变的患者。因此，我们认为 PFO 是鉴别疑似脱髓鞘疾病的关键因素。
