Introduction: Migraine is one of the most common disabling disorders affecting more than 20% of general population at least for once in their lifetime. There are generally two types of migraine headaches, classified as with and without auras, presenting as visual, sensory or motor symptoms. In this study, authors plan to investigate the structural difference between these patients group by Magnetic Resonance Imaging (MRI) in a prospective casecontrol study. Materials and Methods: From August 2015 to October 2017, we have enrolled 40 patients suffering from migraine with aura symptoms into group A, and also we have categorized another 40 patients diagnosed with migraine without any types of aura in group B. These patients were referred to our neurology clinic of one of private hospitals in Tehran. Demographic data and thorough neurological examination performed and they underwent 1.5 Tesla MRI for further assessment of neuro-structures by an expert blinded neuro-radiologist. Statistical analysis was performed by SPSS 17.0 program using Student's T-test and Chi-square test. Results: In group A, there were 9 males and 31 females with mean age of 34.3 years, while there were 13 males and 27 females with mean age of 37.6 years in group B. (P value=0.08) Twenty-five patients in group A experienced visual symptoms, followed by 9 patients with sensory symptoms and 6 patients with motor symptoms. MRI study for group A revealed normal neuro-imaging in 18, pineal and choroid plexus calcification in 8, hyperintense lesions on optic nerve and tract in 4, vascular malformation in 4, hyperintense signal on centrum semiovale in 3 and lateral ventricle asymmetry in 3 patients. While MRI study in group B revealed normal neuro-imaging in 24, hyperintense signal on centrum semiovale in 6 and lateral ventricle asymmetry in 4, dilated ventricles defined by Evans' ratio in 3, pineal and choroid plexus calcification in 2 and brain tumor consistent with meningioma in 1 patient. Conclusion: Authors have found that some specific MRI pattern such as hyperintense lesions on optic nerve and tract and vascular malformation were exclusive to patients who experienced migraine with aura. Also we have noticed that patients without aura tend to have more normal neuro-imaging rather than patients with aura experience. Also we have found that pineal and choroid plexus calcifications were frequent in patients with migraine and aura experience. These findings, especially hyperintense lesions on optic nerve may prompt further evaluation for possible underlying demyelinating and auto-inflammatory and/or auto-immune diseases.

Introduction: Optic Neuritis is defined as inflammation of the optic nerve, which is mostly idiopathic, while demyelinating lesions secondary to auto-immune conditions are among other causes. These lesions are demonstrated on Magnetic Resonance Imaging (MRI) as hyper intensities. In this study, authors plan to investigate the relationship between MRI pattern of patients suffering from optic neuritis, and their pain and visual loss patterns. Materials and Methods: From June 2017 to December 2017, we have enrolled 127 patients suffering from optic neuritis. These patients were referred to neurology and ophthalmology clinic of a private hospital in Tehran. Demographic data of all patients were collected and they underwent MRI for evaluation of optic nerve abnormalities and possible lesions and enhancements. Also, detailed pain score regarding their ocular pain were recorded by an expert blind neurologist, categorizing them into pain with movement, pain during rest and no pain. Also, visual field assessments were performed by an expert blinded ophthalmologist. Statistical analysis performed using SPSS version 17.00 and Student T-test and Mann-whitney test and Chi-square test. Results: There were 110 females and 17 males, with mean age of 35.2 years for females and 39.8 for males. Statistical analysis revealed no significant difference between demographic data of patients. (P value=0.12) Of these patients, 116 cases have abnormalities in their neuro-imaging, which 60 cases have pain in eye movement (group A), 37 cases experienced pain during rest (group B) and 19 cases have no pain (group C). Also, 78 patients have optic nerve enhancement in the orbital segment (39 cases of group A, 28 cases of group B, 11 cases of group C), 16 patients have canalicular segment enhancement (4 cases of group A, 9 cases of group B, 3 cases of group C) and 22 patients have intracranial segment enhancement (13 cases of group A, 6 cases of group B, 3 cases of group C). Also we have found that enhancements longer than 8 mm are consistent with more severe ocular pain, whether during movement or rest. (P value < 0.05) Visual field assessment revealed no significant correlation between type and length of optic nerve enhancement on MRI and visual field loss. (P value=0.09). Conclusion: Authors have found that most of the patients suffering from optic neuritis may demonstrate their symptoms as ocular pain during movement, which most of them have orbital segment involvement of optic nerve. Also, we have found that canalicular optic nerve enhancement were mostly associated with ocular pain at rest, opposed to other types of enhancement (orbital and intracranial). Also, we have found a specific threshold defined as 8 mm of optic nerve enhancement and severity of pain, which is less than other studies in literature.