Goto Fumiyuki, Tsutsumi Tomoko, Ogawa Kaoru
National Hospital Organization Tokyo Medical Center, Department of Otolaryngology.
Nihon Jibiinkoka Gakkai Kaiho. 2013 May;116(5):600-5. doi: 10.3950/jibiinkoka.116.600.
The clinical features of Ménière's disease and migraine-associated vertigo are quite similar. Both disorders are characterized by repeated vertigo spells. Several diagnostic criteria are used to diagnose migraine-associated vertigo. None of these criteria has been internationally defined, although the criteria proposed by Neuhauser are wieldy accepted. Hearing impairment is believed to be a key factor for diagnosing Ménière's disease. We report herein on a case of repeated vertigo spells with sensorineural hearing loss in the right ear. Initially, the condition was diagnosed as Ménière's disease. Treatment for improving endolymphatic hydrops did not have an effect on the vertigo spells. On careful questioning, we noted the coexistence of migraines without any aura. Treatment with Ca antagonists to prevent the migraine attacks successfully stopped the patient's vertigo spells. On the basis of this clinical course, it is safe to assume that the patient had migraine-associated vertigo with sensorineural hearing loss rather than Ménière's disease. For a patient experiencing migraines together with sensorineural hearing loss, an accurate diagnosis requires careful evaluation. The coexistence of migraines should be carefully ruled out, even if Ménière's disease with hearing loss is strongly suspected.
梅尼埃病和偏头痛相关性眩晕的临床特征颇为相似。这两种病症均以反复眩晕发作为特点。有若干诊断标准用于诊断偏头痛相关性眩晕。尽管诺伊豪泽提出的标准被广泛接受,但这些标准均未得到国际上的界定。听力损害被认为是诊断梅尼埃病的关键因素。我们在此报告一例右耳感音神经性听力损失伴反复眩晕发作的病例。起初,该病症被诊断为梅尼埃病。改善内淋巴积水的治疗对眩晕发作并无效果。经仔细询问,我们注意到患者存在无先兆偏头痛。使用钙拮抗剂预防偏头痛发作成功止住了患者的眩晕发作。基于这一临床病程,可以有把握地认为该患者患有伴感音神经性听力损失的偏头痛相关性眩晕而非梅尼埃病。对于同时患有偏头痛和感音神经性听力损失的患者,准确诊断需要仔细评估。即便强烈怀疑为伴有听力损失的梅尼埃病,也应仔细排除偏头痛的并存情况。