Liu Isabelle Y, Ishiyama Akira, Sepahdari Ali R, Johnson Kevin, Ishiyama Gail
Department of Head & Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
Department of Radiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
Headache. 2017 Mar;57(3):455-459. doi: 10.1111/head.12976. Epub 2016 Dec 2.
To use modern high-resolution inner ear imaging modalities to evaluate for endolymphatic hydrops (EH) in a patient with migraine-associated fluctuating hearing loss without vertigo spells or dizziness.
EH has been well described in patients with Meniere's disease on both human temporal bone studies and modern high-resolution imaging; however, there is no study to date, to our knowledge, that examines the presence of EH in a patient with migraine and bilateral hearing loss. We present the MRI findings using a sequence for detecting EH in a unique case of a patient experiencing migraine headaches accompanied by fluctuating hearing loss without vertigo.
Magnetic resonance imaging sequences included "cisternographic" three-dimensional T2, and delayed intravenous-enhanced three-dimensional fluid-attenuation inversion recovery (DIVE-3D-FLAIR) sequences, performed with 2350 ms (bright perilymph) and 2050 ms (bright endolymph) inversion times. The bright endolymph images were subtracted from bright perilymph images to create a composite image with bright perilymph, dark endolymph, and intermediate bone signals.
A 40-year-old female presented with a left-sided sensorineural hearing loss and severe migraine headaches that began at age 12. For the past year, she experienced severe migraines with right-sided fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Audiometry confirmed a drop of right-sided hearing at times of migraines and increased symptom severity. Vestibular testing was within normal limits. MRI demonstrated the presence of severe bilateral vestibular and cochlear EH.
EH of both the cochlea and vestibule can be present in patients without Meniere's disease or vertigo. The relationship between migraine and Meniere's disease may be complex, as demonstrated in this patient with migraine-associated bilateral hearing loss with MRI documentation of severe bilateral EH. The fact that migraine can be associated with EH is important and demonstrates a potential relationship between the pathophysiology of migraine and that of EH. Given this patient's previous association of migraine and hearing loss at age 12, it appears that migrainous attacks occur simultaneously with the hearing loss, and may be potentially causative of the fluctuating hearing loss, mediated possibly through the development of EH. New imaging modalities allow for studies into the field of inner ear pathology, with significant implications for future research.
运用现代高分辨率内耳成像技术，对一名患有偏头痛相关波动性听力损失但无眩晕发作或头晕症状的患者进行内淋巴积水（EH）评估。
在人类颞骨研究和现代高分辨率成像中，梅尼埃病患者的EH已得到充分描述；然而，据我们所知，迄今为止尚无研究探讨偏头痛伴双侧听力损失患者中EH的存在情况。我们展示了一名经历偏头痛性头痛并伴有波动性听力损失且无眩晕的独特病例中，使用检测EH的序列进行MRI检查的结果。
磁共振成像序列包括“脑池造影”三维T2序列，以及延迟静脉增强三维液体衰减反转恢复（DIVE - 3D - FLAIR）序列，反转时间分别为2350毫秒（外淋巴呈高信号）和2050毫秒（内淋巴呈高信号）。从外淋巴高信号图像中减去内淋巴高信号图像，以创建一幅包含高信号外淋巴、低信号内淋巴和中等强度骨信号的合成图像。
一名40岁女性，自12岁起出现左侧感音神经性听力损失和严重偏头痛性头痛。在过去一年中，她经历了伴有右侧波动性感音神经性听力损失、耳鸣和耳闷胀感的严重偏头痛。听力测试证实偏头痛发作时右侧听力下降，且症状严重程度增加。前庭功能测试结果正常。MRI显示存在严重的双侧前庭和耳蜗EH。
耳蜗和前庭的EH可出现在无梅尼埃病或眩晕的患者中。偏头痛与梅尼埃病之间的关系可能很复杂，正如该例患有偏头痛相关双侧听力损失且MRI证实存在严重双侧EH的患者所示。偏头痛可与EH相关这一事实很重要，表明偏头痛的病理生理学与EH的病理生理学之间存在潜在关系。鉴于该患者12岁时曾有偏头痛与听力损失相关联，似乎偏头痛发作与听力损失同时出现，并且可能通过EH的发展潜在地导致波动性听力损失。新的成像技术有助于内耳病理学领域的研究，对未来研究具有重要意义。
