Endolymphatic Hydrops in Patients With Vestibular Migraine and Concurrent Meniere's Disease

Frontiers in Neurology

Bit Na Lee¹  Jin-Ju Kang¹  Seung-Bae Hwang³  Na-Ri Lee⁴  Johannes Gerb⁵  Valerie Kirsch⁵  Rainer Boegle⁵  Marianne Dieterich⁶  Sun-Young Oh⁷ 

[1] Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea;Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany;Department of Radiology, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea;Division of Oncology and Hematology, Department of Internal Medicine, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea;German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany;Munich Cluster for Systems Neurology (SyNergy), Munich, Germany;Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea;

关键词: vestibular migraine;    Meniere's disease;    endolymphatic hydrops;    magnetic resonance imaging;    intravenous gadolinium;    image analysis;   

DOI  :  10.3389/fneur.2021.594481

来源: DOAJ

【 摘 要 】

Objective: Intravenous contrast agent enhanced, high-resolution magnetic resonance imaging of the inner ear (iMRI) confirmed that patients with Menière's disease (MD) and vestibular migraine (VM) could present with endolymphatic hydrops (EH). The present study aimed to investigate EH characteristics and their interrelation to neurotologic testing in patients with VM, MD, or VM with concurrent MD (VM-MD).Methods: Sixty–two patients (45 females, aged 23–81 years) with definite or probable VM (n = 25, 19 definite), MD (n = 29, 17 definite), or showing characteristics of both diseases (n = 8) were included in this study. Diagnostic workup included neurotologic assessments including video-oculography (VOG) during caloric stimulation and head-impulse test (HIT), ocular and cervical vestibular evoked myogenic potentials (o/cVEMP), pure tone audiometry (PTA), as well as iMRI. EH's degree was assessed visually and via volumetric quantification using a probabilistic atlas-based segmentation of the bony labyrinth and volumetric local thresholding (VOLT).Results: Although a relevant number of VM patients reported varying auditory symptoms (13 of 25, 52.0%), EH in VM was only observed twice. In contrast, EH in VM-MD was prevalent (2/8, 25%) and in MD frequent [23/29, 79.3%; χ2(2) = 29.1, p < 0.001, φ = 0.7]. Location and laterality of EH and neurophysiological testing classifications were highly associated (Fisher exact test, p < 0.005). In MD, visual semi-quantitative grading and volumetric quantification correlated highly to each other (rS = 0.8, p < 0.005, two-sided) and to side differences in VOG during caloric irrigation (vestibular EH ipsilateral: rS = 0.6, p < 0.05, two-sided). In VM, correlations were less pronounced. VM-MD assumed an intermediate position between VM and MD.Conclusion: Cochlear and vestibular hydrops can occur in MD and VM patients with auditory symptoms; this suggests inner ear damage irrespective of the diagnosis of MD or VM. The EH grades often correlated with auditory symptoms such as hearing impairment and tinnitus. Further research is required to uncover whether migraine is one causative factor of EH or whether EH in VM patients with auditory symptoms suggests an additional pathology due to MD.

【 授权许可】

Unknown