Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United States of America; Department of Neurosurgery, University of Illinois Peoria Medical School, United States of America.
Department of Radiology, Şehir Hastanesi (City Hospital) and Adjunct Professor of Neuroimaging Sciences, Yıldırım Beyazıt University and Bilkent University, Ankara, Turkey.
Am J Otolaryngol. 2023 Sep-Oct;44(5):103931. doi: 10.1016/j.amjoto.2023.103931. Epub 2023 May 22.
In the absence of papilledema, the presentation of migraine and idiopathic intracranial hypertension (IIH) is very similar. In this respect, an IIH could be presented as a vestibular migraine. Our main objective in this case report is to demonstrate the similarities between IIH and vestibular migraine.
This is a report of 14 patients who have IIH without papilledema presented as vestibular migraine to the clinic and followed from 2020 to 2022.
The common presentation of patients was ear-facial pain, dizziness, and frequent pulsatile tinnitus. One-fourth of the patients reported episodes of true episodic vertigo. The average age was 37.8, the average BMI was 37.4, and the average lumbar puncture-opening pressure was 25.6 cm HO. Transverse sinus venous flow alterations caused neuroimaging findings of sigmoid sinus dehiscence, empty sella, or tonsillar ectopia. Most patients improved with carbonic anhydrase inhibitors, and one patient was treated with a dural sinus stent.
A transverse sinus stenosis, even in the non-dominant site, may elevate the CSF pressure in obese individuals. This stenosis causes dural sinus-related pulsatile tinnitus with characteristics different from those of an arterial origin. Dizziness is a common complaint in patients with IIH, just like VM. In our opinion, episodic vertigo in these patients is the direct effect of CSF flow alterations into the inner ear's vestibule. Patients with mild elevations will be presented to the clinic, similar to migraines with or without the presence of pulsatile tinnitus. Treatment requires lowering intracranial pressure and managing migraine symptoms.
在没有视乳头水肿的情况下，偏头痛和特发性颅内高压（IIH）的表现非常相似。在这方面，IIH 可能表现为前庭性偏头痛。我们在本病例报告中的主要目的是展示 IIH 和前庭性偏头痛之间的相似之处。
这是一份报告，其中有 14 名患有 IIH 但无视乳头水肿的患者，他们表现为前庭性偏头痛，于 2020 年至 2022 年就诊并接受了随访。
患者的常见表现为耳面部疼痛、头晕和频繁的搏动性耳鸣。四分之一的患者报告有真性阵发性眩晕发作。平均年龄为 37.8 岁，平均 BMI 为 37.4，平均腰椎穿刺开口压力为 25.6cmH₂O。横窦静脉血流改变导致了乙状窦裂孔、空蝶鞍或扁桃体异位等神经影像学发现。大多数患者用碳酸酐酶抑制剂治疗后得到改善，有 1 名患者接受了硬脑膜窦支架治疗。
即使在非优势部位，横窦狭窄也可能使肥胖个体的 CSF 压力升高。这种狭窄引起与硬脑膜窦相关的搏动性耳鸣，其特征与动脉来源的不同。头晕是 IIH 患者的常见症状，就像 VM 一样。在我们看来，这些患者的阵发性眩晕是 CSF 流入内耳前庭引起的直接作用。轻度升高的患者会就诊，类似于有或无搏动性耳鸣的偏头痛。治疗需要降低颅内压和治疗偏头痛症状。
