Abstract Details

Title Beyond Non-specific White Matter Abnormalities – Is There a Causal Relationship with Patent Foramen Ovale?

Topic Headache

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 15-008

Objective

To investigate the potential relationship between nonspecific white matter abnormalities (NSWMA) and right-to-left shunt (RLS) detected by transcranial Doppler ultrasound (TCD), and to explore the role of patent foramen ovale (PFO) in the pathogenesis of these lesions.

Background NSWMAs are frequently encountered on brain MRI, often in patients presenting with headache. NSWMA is defined by: 1) small (<3 mm), nodular white matter lesions, 2) non-ovoid morphology without a central vein sign, 3)predominant localization in subcortical regions, 4) a semi-symmetric distribution, 5) absence of gadolinium enhancement, 6) absence of radiological features typical of demyelinating etiologies. The pathogenesis of NSWMA remains uncertain, with proposed mechanisms including microvascular ischemia, inflammatory processes, and paradoxical embolism via patent foramen ovale (PFO).

Design/Methods Patients aged 18–55 years with MRI findings fulfilling NSWMA criteria were included. All participants underwent contrast-enhanced TCD to evaluate for RLS, and transthoracic and/or transesophageal echocardiography to confirm PFO. MRI findings were retrospectively evaluated for lesion size, morphology, and distribution.

Results Among 104 patients (mean age 44.4±9.7 years; 86.5% female), 51.9% were TCD-positive. Headache was significantly more frequent among TCD-positive patients (p=0.0048), who also demonstrated higher PFO positivity (p<0.0001) and closure rates (p=0.0003). In contrast, TCD-negative patients exhibited a greater lesion burden, including higher numbers of periventricular and juxtacortical lesions (p<0.05 for all), more frequent symmetric/semi-symmetric patterns (p=0.02), and larger lesion sizes (p=0.03). None of the patients displayed infratentorial or spinal cord involvement.

Conclusions The significant association between PFO-related shunting and headache supports a possible embolic or vasoactive contribution to certain NSWMA presentations. However, the higher lesion load in TCD-negative patients suggests that NSWMA represents a heterogeneous, non-demyelinating entity with multifactorial origins, with the possibility of a genetic origin. These findings emphasize the importance of recognizing NSWMA as a distinct radiological pattern requiring careful differential diagnosis in patients with incidental white matter findings.

Authors/Disclosures
Bade Gulec PRESENTER	Bade Gulec has nothing to disclose.
Merve H. Ser	Merve H. Ser has nothing to disclose.
Elif Everest, PhD (National Institutes of Health)	Ms. Everest has received personal compensation in the range of $50,000-$99,999 for serving as a postdoctoral visiting fellow with National Institutes of Health.
Özgür Selim Ser (Istanbul Cemil Tascıoglu City Hospital)	No disclosure on file
Eser Durmaz (Istanbul University Cerrahpasa School of Medicine)	No disclosure on file
Derya U. Ugurlu, MD (Istanbul University Cerrahpasa Tip Fakultesi)	Dr. Ugurlu has nothing to disclose.
Melih Tutuncu, MD (ISTANBUL UNIVERSITESI CERRAHPASA TIP FAKULTESI)	Dr. Tutuncu has nothing to disclose.
Ugur Uygunoglu (Cerrahpasa)	Ugur Uygunoglu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Turkey . The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen Idec/Gen Pharma of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck-Serono of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanovel of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Genveon of Turkey.
Sabahattin Saip	Sabahattin Saip has nothing to disclose.
Aksel Siva, MD (Istanbul University Cerrahpasa School of Medicine)	Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ali Raif Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanovel Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abdi Ibrahim Ilac - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono . The institution of Dr. Siva has received research support from Turkish MS Society. The institution of Dr. Siva has received research support from The Scientific and Technological Research Council Of Turkey - Health Sciences Research Grants.

��ɫ��

��ɫ��