Meniere's disease and vestibular migraine: similarities, differences, and relationships from the viewpoint of physiological examinations

Abstract

メニエール病は,反復するめまいと聴覚症状を呈 する末梢前庭疾患の代表として知られており,その 病態は内リンパ水腫であると考えられている。 その病態生理については,これまでに多数の基礎 的・臨床的研究がなされており,前庭性疾患のなか では比較的知見が多いといえる。一方,前庭性片 頭痛(vestibular migraine:VM)は,反復するめま いを呈する比較的あたらしい疾患概念である。以 前よりめまいと片頭痛が関連することは知られてお り,それらを片頭痛関連めまい(migraine associated vertigo),片頭痛性めまい(migrainous verMeniere’s disease refers to a peripheral vestibular disorder characterized by recurrent vertigo and cochlear symptoms, and the underlying pathophysiology is thought to be endolymphatic hydrops. Vestibular migraine is a relatively new disease concept that manifests as recurrent vertigo, whose pathophysiology still remains unclear. Comparison of the physiological characteristics of these two diseases might help in elucidating the pathophysiology of vestibular migraine, and in this paper, the similarities and differences between the two diseases are described from the viewpoint of the findings of physiological examination. Meniere’s disease is characterized by unilateral vestibular dysfunction, which is not disease-specific. Positive results of tests for endolymphatic hydrops, such as the furosemide test and furosemide-loading VEMP are specific for the disease. Patients who showed unilateral canal paresis on caloric testing did not show lower VOR gain in the video head impulse test (vHIT), which is also specific for the disease. About 18%―42% of patients with vestibular migraine show unilateral dysfunction on caloric testing. Many patients with unilateral canal paresis on caloric testing did not show a low VOR gain on vHIT, similar to the case of Meniere’s disease. The peak-to-peak amplitude of cVEMP and oVEMP may show a decrease. Some tests for endolymphatic hydrops show positive results. The findings could be summarized as follows; vestibular dysfunction is not uncommon in vestibular migraine. The tests show that endolymphatic hydrops could be associated with vestibular migraine, however, it is not clear if this is the cause or the result of the disease. パネルディスカッション「メニエール病と前庭性片頭痛:その類似点と相違点,関係性」