Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea.
Cephalalgia. 2014 Jan;34(1):58-67. doi: 10.1177/0333102413498940. Epub 2013 Aug 5.
Vestibular symptoms/signs frequently coexist with migraine, but the mechanisms of migraine-related vestibular dysfunction remain to be elucidated. This study aimed to determine altered brain metabolism in vestibular migraine.
Two patients with vestibular migraine underwent (18)F-fluorodeoxy glucose (FDG) positron-emission tomography (PET) during and between attacks of vestibular migraine in addition to detailed neurotological evaluation. We analyzed the regional brain metabolism of the patients in comparison with that of age-matched healthy controls in each patient. We also compared ictal with interictal FDG PET using a subtraction method.
During the attacks, both patients showed an activation of the bilateral cerebellum and frontal cortices, and deactivation of the bilateral posterior parietal and occipitotemporal areas. One patient also showed hypermetabolism in the dorsal pons and midbrain, right posterior insula, and right temporal cortex while the other patient had an additional activation of the left temporal cortex. Compared with interictal images, ictal PET showed increased metabolism in the bilateral cerebellum, frontal cortices, temporal cortex, posterior insula, and thalami.
During the attacks of vestibular migraine, the increased metabolism in the temporo-parieto-insular areas and bilateral thalami indicates activation of the vestibulo-thalamo-cortical pathway, and decreased metabolism in the occipital cortex may represent reciprocal inhibition between the visual and vestibular systems.
前庭症状/体征常与偏头痛并存，但偏头痛相关前庭功能障碍的机制仍有待阐明。本研究旨在确定前庭性偏头痛患者的脑代谢改变。
两名前庭性偏头痛患者在发作期间和发作之间接受了（18）F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）检查，此外还进行了详细的神经耳科学评估。我们分析了患者的局部脑代谢情况，并与每位患者的年龄匹配的健康对照组进行了比较。我们还使用减影法比较了发作期和发作间期的 FDG PET。
在发作期间，两名患者均表现出双侧小脑和额叶皮质的激活，以及双侧顶后和枕颞区域的失活。一名患者还表现出桥脑和中脑背侧、右侧后岛叶和右侧颞叶皮质的高代谢，而另一名患者的左侧颞叶皮质也有额外的激活。与发作间期图像相比，发作期 PET 显示双侧小脑、额叶皮质、颞叶皮质、后岛叶和丘脑的代谢增加。
在前庭性偏头痛发作期间，颞顶岛皮质和双侧丘脑的代谢增加表明前庭-丘脑-皮质通路的激活，枕叶皮质的代谢减少可能代表视觉和前庭系统之间的相互抑制。
