Department of Neurology, Charité, Augustenburger Platz 1, Berlin, Germany.
Cephalalgia. 2011 Jun;31(8):906-13. doi: 10.1177/0333102411405228. Epub 2011 Apr 20.
Clinical recognition of vestibular migraine (VM) is still hampered by the lack of consensus diagnostic criteria. The aim of this study is a long-term evaluation of clinical criteria for definite (dVM) and probable (pVM) vestibular migraine.
We re-assessed 75 patients (67 women, age 24-76 years) with dVM (n=47) or pVM (n=28) according to previously published criteria after a mean follow-up of 8.75±1.3 years. Assessment included a comprehensive neurotological clinical examination, pure tone audiometry and caloric testing.
dVM was confirmed in 40 of 47 patients with a prior diagnosis of dVM (85%). Fourteen of 28 patients initially classified as pVM met criteria for dVM (50%), nine for pVM (32%). Six additional patients with dVM and two with pVM had developed mild sensorineural hearing loss, formally fulfilling criteria for bilateral Menière's disease (MD), but had clinical features atypical of MD. Seven of these also met criteria for dVM at follow-up. The initial diagnosis was completely revised for four patients.
Although VM diagnosis lacks a gold standard for evaluation of diagnostic criteria, repeated comprehensive neurotological evaluation after a long follow-up period indicates not only high reliability but also high validity of presented clinical criteria (positive predictive value 85%). Half of patients with pVM evolve to meet criteria for dVM. However, in a subgroup of VM patients with hearing loss, criteria for dVM and MD are not sufficiently discriminative.
目前，临床医生对前庭性偏头痛（VM）的认识仍受到缺乏共识诊断标准的阻碍。本研究旨在对明确（dVM）和可能（pVM）前庭性偏头痛的临床标准进行长期评估。
我们根据先前发表的标准，重新评估了 75 例（67 名女性，年龄 24-76 岁）dVM（n=47）或 pVM（n=28）患者，平均随访时间为 8.75±1.3 年。评估包括全面的神经耳科学临床检查、纯音听力测试和冷热试验。
在先前诊断为 dVM 的 47 例患者中，有 40 例（85%）得到了确认。28 例最初被归类为 pVM 的患者中有 14 例（50%）符合 dVM 的标准，9 例（32%）符合 pVM 的标准。另外 6 例 dVM 患者和 2 例 pVM 患者出现了轻度感音神经性听力损失，符合双侧梅尼埃病（MD）的标准，但临床特征不典型。其中 7 例在随访时也符合 dVM 的标准。有 4 例患者的初始诊断被完全修正。
尽管 VM 诊断缺乏评估诊断标准的金标准，但在长期随访后进行反复全面的神经耳科学评估不仅表明了所提出的临床标准具有较高的可靠性，而且具有较高的有效性（阳性预测值为 85%）。一半的 pVM 患者进展为符合 dVM 的标准。然而，在具有听力损失的 VM 患者亚组中，dVM 和 MD 的标准区分度不足。
