Department of Neurology, Charité, University Freiburg, Berlin, Germany.
Neurology. 2012 Oct 9;79(15):1607-14. doi: 10.1212/WNL.0b013e31826e264f. Epub 2012 Sep 26.
The aim of the study was to assess the evolution of clinical symptoms and vestibulo-cochlear function in patients with definite vestibular migraine (dVM).
We reassessed 61 patients (54 women, 7 men, aged 24-76 years) with dVM according to validated diagnostic criteria after a median follow-up time of 9 years (range, 5.5-11). Assessment comprised a clinical interview and neurotologic examination, including pure-tone audiometry and caloric testing.
The majority of patients (87%) had recurrent vertigo at follow-up. Frequency of vertigo was reduced in 56%, increased in 29%, and unchanged in 16%. Impact of vertigo was severe in 21%, moderate in 43%, and mild in 36%. Eighteen percent reported mild persistent unsteadiness. Interictal ocular motor abnormalities had increased from 16% initially to 41% of patients at follow-up. The most frequent finding was positional nystagmus (PN), in 28%, including definite central-type PN in 18%. However, only 1 of 9 patients with ocular motor abnormalities at initial presentation showed similar findings on follow-up. Concomitant cochlear symptoms with vertigo had increased from 15% initially to 49%. Eleven patients (18%) had developed mild bilateral sensorineural hearing loss, which also involved the low-frequency range.
The majority of patients continue to have recurrent vertigo in the long-term evolution of VM, and the impact of vertigo may remain severe. Whereas interictal ocular motor abnormalities may show some variation over time, vestibulo-cochlear dysfunction progresses slowly in some patients with VM. Interictal central-type PN may help distinguish VM from peripheral vestibular disorders such as Ménière disease.
本研究旨在评估明确的前庭性偏头痛（dVM）患者的临床症状和前庭耳蜗功能演变。
我们根据已验证的诊断标准，在中位随访时间 9 年后（范围，5.5-11 年）重新评估了 61 例（54 名女性，7 名男性，年龄 24-76 岁）dVM 患者。评估包括临床访谈和神经耳科学检查，包括纯音听力测试和冷热试验。
大多数患者（87%）在随访时出现复发性眩晕。眩晕频率减少了 56%，增加了 29%，无变化 16%。眩晕的影响严重占 21%，中度占 43%，轻度占 36%。18%的患者报告有轻度持续性不稳。间发性眼球运动异常从最初的 16%增加到随访时的 41%。最常见的发现是位置性眼球震颤（PN），占 28%，包括 18%的明确中枢型 PN。然而，最初有眼球运动异常的 9 例患者中只有 1 例在随访时出现类似表现。伴有眩晕的同时耳蜗症状从最初的 15%增加到 49%。11 例（18%）患者出现轻度双侧感音神经性听力损失，也累及低频范围。
在 VM 的长期演变中，大多数患者仍会反复发作眩晕，且眩晕的影响可能仍然严重。虽然间发性眼球运动异常可能随时间发生一些变化，但前庭耳蜗功能障碍在一些 VM 患者中进展缓慢。间发性中枢型 PN 有助于将 VM 与梅尼埃病等外周性前庭障碍区分开来。
