Huppert Doreen, Grill Eva, Becker-Bense Sandra, Zwergal Andreas, Strobl Ralf
German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany.
Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
J Neurol. 2025 Aug 5;272(9):558. doi: 10.1007/s00415-025-13291-x.
Vestibular migraine (VM) and Menière's disease (MD) are spontaneous episodic vestibular syndromes and often present with overlapping features, making clinical differentiation challenging. This study aimed to (1) identify key features distinguishing VM from MD and (2) investigate discrepancies between expert diagnosis and International Classification of Vestibular Disorders (ICVD) criteria for VM.
We analyzed data from patients diagnosed with VM or MD at the tertiary dizziness center of LMU Munich. Diagnostic classification was based on ICVD criteria and expert judgment. Symptoms, vestibulo-ocular reflex (VOR) function, and demographics were compared. A conditional inference tree identified key differentiators. For 'suspected VM' cases not meeting ICVD criteria, reasons for diagnostic discrepancy were analyzed.
We included 290 patients: 188 with VM and 88 with MD. VM was more common in women (72% vs. 51%) and had an earlier onset (39.6 vs. 49.9 years). MD patients had more rotational vertigo, greater caloric asymmetry, and lower VOR gains on video head impulse testing (all p < 0.0001). The tree identified seven key variables and achieved 86% accuracy. Sixty-six VM patients were diagnosed as 'suspected VM' based on expert judgment. Discrepancies were primarily due to short attack duration and atypical symptoms.
This study identified seven clinical variables to effectively distinguish VM from MD. While VM and MD share overlapping features, diagnostic ambiguity remains common, particularly in cases not meeting ICVD criteria. Our findings support the introduction of a 'suspected VM' category to capture patients with atypical presentations not covered by ICVD criteria.
前庭性偏头痛（VM）和梅尼埃病（MD）是自发性发作性前庭综合征，常具有重叠特征，这使得临床鉴别具有挑战性。本研究旨在：（1）确定区分VM与MD的关键特征；（2）调查专家诊断与VM的国际前庭疾病分类（ICVD）标准之间的差异。
我们分析了慕尼黑大学附属三级眩晕中心诊断为VM或MD的患者的数据。诊断分类基于ICVD标准和专家判断。比较了症状、前庭眼反射（VOR）功能和人口统计学特征。通过条件推断树确定关键鉴别因素。对于不符合ICVD标准的“疑似VM”病例，分析诊断差异的原因。
我们纳入了290例患者：188例VM患者和88例MD患者。VM在女性中更常见（72%对51%），且发病更早（39.6岁对49.9岁）。MD患者在视频头脉冲测试中有更多的旋转性眩晕、更大的冷热试验不对称性和更低的VOR增益（所有p<0.0001）。该树确定了七个关键变量，准确率达到86%。66例VM患者根据专家判断被诊断为“疑似VM”。差异主要归因于发作持续时间短和症状不典型。
本研究确定了七个临床变量，可有效区分VM与MD患者。虽然VM和MD有重叠特征，但诊断模糊仍然很常见，特别是在不符合ICVD标准的病例中。我们的研究结果支持引入“疑似VM”类别，以涵盖ICVD标准未涵盖的非典型表现患者。
