Transient endolymphatic hydrops after an attack of vestibular migraine: a longitudinal single case study

Kirsch, V.; Becker‐Bense, Sandra; Berman, Albert; Kierig, E.; Ertl‐Wagner, Birgit; Dieterich, Marianne

doi:10.1007/s00415-018-8870-3

Cited by 28 publications

(18 citation statements)

References 17 publications

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“…Furthermore, the trigeminovascular system projects to the labyrinthine arteries of either labyrinth, which might result in symmetrical involvement of both labyrinth organs in VM [9]. The symmetrical responses for o-and cVEMPs in VM fit with the recent observation of mild bilateral ELH in inner ear magnetic resonance imaging (MRI) of patients with VM [39].…”

Section: Vemp Responses In Vestibular Migrainesupporting

confidence: 71%

Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Dlugaiczyk

Dieterich

2020

J Neurol

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Objective Vestibular evoked myogenic potentials (VEMPs) have been suggested as biomarkers in the differential diagnosis of Menière's disease (MD) and vestibular migraine (VM). The aim of this study was to compare the degree of asymmetry for ocular (o) and cervical (c) VEMPs in large cohorts of patients with MD and VM and to follow up the responses. Study design Retrospective study in an interdisciplinary tertiary center for vertigo and balance disorders. Methods cVEMPs to air-conducted sound and oVEMPs to bone-conducted vibration were recorded in 100 patients with VM and unilateral MD, respectively. Outcome parameters were asymmetry ratios (ARs) of oVEMP n10p15 and cVEMP p13n23 amplitudes, and of the respective latencies (mean ± SD). Results The AR of cVEMP p13n23 amplitudes was significantly higher for MD (0.43 ± 0.34) than for VM (0.26 ± 0.24; adjusted p = 0.0002). MD-but not VM-patients displayed a higher AR for cVEMP than for oVEMP amplitudes (MD 0.43 ± 0.34 versus 0.23 ± 0.22, p < 0.0001; VM 0.26 ± 0.14 versus 0.19 ± 0.15, p = 0.11). Monitoring of VEMPs in single patients indicated stable or fluctuating amplitude ARs in VM, while ARs in MD appeared to increase or remain stable over time. No differences were observed for latency ARs between MD and VM. Conclusions These results are in line with (1) a more common saccular than utricular dysfunction in MD and (2) a more permanent loss of otolith function in MD versus VM. The different patterns of o-and cVEMP responses, in particular their longitudinal assessment, might add to the differential diagnosis between MD and VM.

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Section: Vemp Responses In Vestibular Migrainesupporting

confidence: 71%

Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Dlugaiczyk

Dieterich

2020

J Neurol

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“…In another study, conducted by Gürkov et al [24], it was demonstrated that VM had a less frequent prevalence of endolymphatic hydrops than in MD. In VM, transient endolymphatic hydrops has also been described [25]. The challenges in diagnosis of MD and VM has been highlighted by Phillips et al [14], who has criticized the loosely assessed diagnoses of vertigo attacks with migraine, and thus stated that VM has emerged as a popular diagnosis to fill the void left by the entity known as "vestibular MD" to search for a better explanation.…”

mentioning

confidence: 99%

Association between Ménière’s disease and vestibular migraine

Pyykkö

Manchaiah

Färkkilä³

et al. 2019

Auris Nasus Larynx

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“…If discrepancies arose, a consensus was reached by discussion. The characterization of the ELS in the vestibulum and cochlea was based on criteria previously described [12], which constitutes a fusion of two classification systems [38,39]. D1 and D3 did not differ significantly concerning the grade of ELH.…”

Section: D1 and D3-sequence Protocol And Grading Of The Delayed Gadolmentioning

confidence: 99%

“…Today, the relationship between ELH and MD symptoms (for review cp [3]), as well as the specificity of ELH for MD, has come under scrutiny. The underlying reason is that different ELH patterns can be found not only in MD [4,5], but also so far in 3.3-28% of healthy ears [6,7], various inner ear [8][9][10] and central [11][12][13][14] pathologies, as well as in anatomic or vascular abnormalities affecting endolymph resorption [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

et al. 2020

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Background Objective and volumetric quantification is a necessary step in the assessment and comparison of endolymphatic hydrops (ELH) results. Here, we introduce a novel tool for automatic volumetric segmentation of the endolymphatic space (ELS) for ELH detection in delayed intravenous gadolinium-enhanced magnetic resonance imaging of inner ear (iMRI) data. Methods The core component is a novel algorithm based on Volumetric Local Thresholding (VOLT). The study included three different data sets: a real-world data set (D1) to develop the novel ELH detection algorithm and two validating data sets, one artificial (D2) and one entirely unseen prospective real-world data set (D3). D1 included 210 inner ears of 105 patients (50 male; mean age 50.4 ± 17.1 years), and D3 included 20 inner ears of 10 patients (5 male; mean age 46.8 ± 14.4 years) with episodic vertigo attacks of different etiology. D1 and D3 did not differ significantly concerning age, gender, the grade of ELH, or data quality. As an artificial data set, D2 provided a known ground truth and consisted of an 8-bit cuboid volume using the same voxel-size and grid as real-world data with different sized cylindrical and cuboid-shaped cutouts (signal) whose grayscale values matched the real-world data set D1 (mean 68.7 ± 7.8; range 48.9-92.8). The evaluation included segmentation accuracy using the Sørensen-Dice overlap coefficient and segmentation precision by comparing the volume of the ELS. Results VOLT resulted in a high level of performance and accuracy in comparison with the respective gold standard. In the case of the artificial data set, VOLT outperformed the gold standard in higher noise levels. Data processing steps are fully automated and run without further user input in less than 60 s. ELS volume measured by automatic segmentation correlated significantly with the clinical grading of the ELS (p < 0.01). Conclusion VOLT enables an open-source reproducible, reliable, and automatic volumetric quantification of the inner ears' fluid space using MR volumetric assessment of endolymphatic hydrops. This tool constitutes an important step towards comparable and systematic big data analyses of the ELS in patients with the frequent syndrome of episodic vertigo attacks. A generic version of our three-dimensional thresholding algorithm has been made available to the scientific community via GitHub as an ImageJ-plugin.

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Transient endolymphatic hydrops after an attack of vestibular migraine: a longitudinal single case study

Cited by 28 publications

References 17 publications

Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Association between Ménière’s disease and vestibular migraine

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

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