Can Vestibular-Evoked Myogenic Potentials Help Differentiate Ménière Disease from Vestibular Migraine?

Operative measures are considered when medical treatment fails to control vertigo in patients with intractable Ménière disease. The present report discusses a case in which triple semicircular canal occlusion was performed in a 30-year-old female patient who responded poorly to previously performed endolymphatic sac surgery. Her vestibular and auditory functions were evaluated both before and after surgery. Class A control of vertigo was achieved during the 76-month postoperative follow-up period. Ocular and cervical vestibular evoked myogenic potentials could be elicited before and after surgery. This case suggests that relatively long-term preservation of otolithic function can be achieved following triple semicircular canal occlusion, highlighting its potential as an alternative treatment for patients with Ménière disease.

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Cervical vestibular evoked myogenic potentials and video head impulse test in Ménière disease

Brazilian Journal of Otorhinolaryngology ◽

10.1016/j.bjorl.2019.02.002 ◽

2020 ◽

Vol 86 (5) ◽

pp. 534-544 ◽

Cited By ~ 2

Author(s):

Thaís Alvares de Abreu e Silva Grigol ◽

Karen de Carvalho Lopes ◽

Fernando Freitas Ganança

Keyword(s):

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Meniere Disease ◽

Head Impulse ◽

Menière Disease

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Ictal downbeat nystagmus in Ménière disease

Neurology ◽

10.1212/wnl.0000000000010653 ◽

2020 ◽

Vol 95 (17) ◽

pp. e2409-e2417

Author(s):

Sun-Uk Lee ◽

Hyo-Jung Kim ◽

Jeong-Yoon Choi ◽

Ji-Soo Kim

Keyword(s):

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Slow Phase ◽

Downbeat Nystagmus ◽

Meniere Disease ◽

Head Impulse ◽

Slow Phase Velocity ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex ◽

Menière Disease

ObjectiveTo determine the mechanism of ictal downbeat nystagmus in Ménière disease (MD), we compared the head impulse gain of the vestibulo-ocular reflex (VOR) for each semicircular canal between patients with (n = 7) and without (n = 70) downbeat nystagmus during attacks of MD.MethodsWe retrospectively analyzed the results of video-oculography, video head-impulse tests, and cervical vestibular-evoked myogenic potentials (VEMPs) in 77 patients with definite MD who were evaluated during an attack.ResultsPure or predominant downbeat nystagmus was observed in 7 patients (9%) with unilateral MD during the attacks. All 7 patients showed spontaneous downbeat nystagmus without visual fixation with a slow phase velocity ranging from 1.5 to 11.2°/s (median 5.4, interquartile range 3.7–8.5). All showed a transient decrease of the head impulse VOR gains for the posterior canals (PCs) in both ears (n = 4) or in the affected ear (n = 3). Cervical VEMPs were decreased in the affected (n = 2) or both ears (n = 2) when evaluated during the attacks. Downbeat nystagmus disappeared along with normalization of the VOR gains for PCs after the attacks in all patients. During the attacks, the head impulse VOR gains for the PC on the affected side were lower in the patients with ictal downbeat nystagmus than in those without (Mann-Whitney U test, p < 0.001), while the gains for other semicircular canals did not differ between the groups.ConclusionDownbeat nystagmus may be observed during attacks of MD due to an asymmetry in the vertical VOR or saccular dysfunction. MD should be considered in recurrent audiovestibulopathy and ictal downbeat nystagmus.

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Metabolic factors in pathogenesis of migraine and unsteadiness

Medical alphabet ◽

10.33667/2078-5631-2020-33-18-20 ◽

2021 ◽

pp. 18-20

Author(s):

A. S. Bedenko

Keyword(s):

Vestibular Migraine ◽

Common Element ◽

Primary Headaches ◽

Vestibular Disorders ◽

Metabolic Factors ◽

Meniere Disease ◽

Positional Vertigo ◽

Common Causes ◽

Menière Disease ◽

High Comorbidity

Headache and dizziness are common causes of applicion for neurological care. Migraine, being one of the most common causes of primary headaches, may lead to development of vestibular disorders both transient and persistent. Pathogenesis of vestibular migraine is poorly investigated. It is remarkable, that the high comorbidity between migraine and peripherial vestibular disorders, such as Meniere disease and benign paroxysamal positional vertigo is observed. Metabolic factors may be such an integrative common element of pathogenesis for these conditions. The crucial research works of recent years, devoted to this problem, are considered in this manuscript.

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The Intimate Relationship between Vestibular Migraine and Meniere Disease: A Review of Pathogenesis and Presentation

Behavioural Neurology ◽

10.1155/2016/3182735 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 16

Author(s):

Yuan F. Liu ◽

Helen Xu

Keyword(s):

Intimate Relationship ◽

Vestibular Migraine ◽

Current Understanding ◽

Vestibular Disorders ◽

Disease Entity ◽

Meniere Disease ◽

Distinct Disease ◽

Common Etiology ◽

Menière Disease ◽

Distinct Disease Entity

Vestibular migraine (VM) has only recently been recognized as a distinct disease entity. One reason is that its symptoms overlap greatly with those of other vestibular disorders, especially Meniere disease (MD). The pathophysiology of neither VM nor MD is entirely elucidated. However, there are many theories linking migraine to both disorders. We reviewed the current understanding of migraine, VM, and MD and described how VM and MD are similar or different from each other in terms of pathophysiology and presentation, including hypotheses that the two share a common etiology and/or are variants of the same disease.

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Vestibular mapping in patients with unilateral peripheral-vestibular deficits

Neurology ◽

10.1212/wnl.0000000000010812 ◽

2020 ◽

Vol 95 (22) ◽

pp. e2988-e3001

Author(s):

Alexander A. Tarnutzer ◽

Christopher J. Bockisch ◽

Elena Buffone ◽

Konrad P. Weber

Keyword(s):

Cluster Analysis ◽

Vestibular Schwannoma ◽

Hierarchical Cluster Analysis ◽

Case Series ◽

Hierarchical Cluster ◽

Vestibular Evoked Myogenic Potentials ◽

Meniere Disease ◽

Vestibular Loss ◽

Horizontal Canal ◽

Menière Disease

ObjectiveTo test the hypothesis that patterns of semicircular canal (SCC) and otolith impairment in unilateral vestibular loss depend on the underlying disorders, we analyzed peripheral-vestibular function of all 5 vestibular sensors.MethodsFor this retrospective case series, we screened the hospital video-head-impulse test database (n = 4,983) for patients with unilaterally impaired SCC function who also received ocular vestibular-evoked myogenic potentials and cervical vestibular-evoked myogenic potentials (n = 302). Frequency of impairment of vestibular end organs (horizontal/anterior/posterior SCC, utriculus/sacculus) was analyzed with hierarchical cluster analysis and correlated with the underlying etiology.ResultsAcute vestibular neuropathy (AVN) (37.4%, 113 of 302), vestibular schwannoma (18.2%, 55 of 302), and acute cochleovestibular neuropathy (6.6%, 20 of 302) were most frequent. Horizontal SCC impairment (87.4%, 264 of 302) was more frequent (p < 0.001) than posterior (47.4%, 143 of 302) and anterior (37.8%, 114 of 302) SCC impairment. Utricular damage (58%, 175 of 302) was noted more often (p = 0.003) than saccular impairment (32%, 98 of 302). On average, 2.6 (95% confidence interval 2.48–2.78) vestibular sensors were deficient, with higher numbers (p ≤ 0.017) for acute cochleovestibular neuropathy and vestibular schwannoma than for AVN, Menière disease, and episodic vestibular syndrome. In hierarchical cluster analysis, early mergers (posterior SCC/sacculus; anterior SCC/utriculus) pointed to closer pathophysiologic association of these sensors, whereas the late merger of the horizontal canal indicated a more distinct state.ConclusionsWhile the extent and pattern of vestibular impairment critically depended on the underlying disorder, more limited damage in AVN and Menière disease was noted, emphasizing the individual range of loss of function and the value of vestibular mapping. Likely, both the anatomic properties of the different vestibular end organs and their vulnerability to external factors contribute to the relative sparing of the vertical canals and the sacculus.

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