Are Periventricular Lesions Specific for Multiple Sclerosis?

BACKGROUND: The presence of periventricular lesions (PVL) on MRI scans is part of the revised McDonald multiple sclerosis (MS) diagnostic criteria. However, PVL can be found in other neurological diseases including stroke and migraine. Migraine is highly prevalent in patients with MS. OBJECTIVE: To determine if PVL are specific for patients with MS compared to stroke and migraine. METHODS: We studied patients diagnosed with clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), migraine, and ischemic stroke. The number, location and the volume of PVL were identified on brain MRI scans and analyzed. RESULTS: The number and volume of PVL adjacent to the body and the posterior horn of the lateral ventricles were significantly increased on fluid-attenuated inversion recovery MRI in RRMS compared to migraine. There were no significant differences in the total number and volume of PVL in ischemic stroke patients compared to the age-matched RRMS patients nor in the number and volume of PVL adjacent to the anterior and temporal horns of the lateral ventricles on FLAIR images in migraine compared to CIS or RRMS. CONCLUSION: In contrast to PVL adjacent to the body and the posterior horn of the lateral ventricles, PVL adjacent to the anterior and temporal horns of the lateral ventricles may not be specific for CIS/RRMS when compared to migraine, the disease highly prevalent among patients with MS. PVL are not specific for MS when compared to ischemic stroke.