Eye movements and imaging in vestibular migraine / Movimientos oculares y pruebas de imagen en migraña vestibular

BACKGROUND AND OBJECTIVE: Migrainous dizziness is one of the most frequent complaints. Dizziness associated with migraine may be the result of abnormal eye movements. Brain imaging and changes in eye movements may explain the dizziness and highlight possible pathophysiological substrates in migraine dizziness. Our aim is to evaluate eye movement using videonystagmography (VNG) and video head impulse test (vHIT) and to study the occipital lobe metabolic profile in vestibular migraine patients (VM). MATERIALS AND METHODS: There were 2 groups enrolled in the study; the first group consisted of 25 vestibular migraine patients (VM) according to the recent criteria of Barany society. The second group consisted of 20 age matched healthy subjects. Both groups underwent the following: (1) A detailed history, VNG test protocol, vHIT in three planes. (2) Magnetic resonance imaging (MRI) for the brain and inner ear using 1.5 T magnet and proton magnetic resonance spectroscopy (H1-MRS). RESULTS: Sixty eight percent of the patients complained of spontaneous vertigo and 28% complained of positional vertigo. Non-paroxysmal positional nystagmus was recorded in 92% during their dizzy spell. The brain MRI was unremarkable in 72% of the cases. Chemical shift in the occipital lobe was found in 92% of VM. Lactate peaks were statistically significant related with the presence of non-paroxysmal positional nystagmus. CONCLUSIONS: A statistically significant relationship exists between non-paroxysmal positional nystagmus and presence of lactate peaks in the occipital lobe in VM patients

ANTECEDENTES Y OBJETIVO: El mareo migrañoso es una de las quejas más frecuentes. Las pruebas de imagen del cerebro y los cambios en los movimientos oculares pueden explicar los mareos y destacar los posibles sustratos fisiopatológicos en la migraña vestibular. Nuestro objetivo fue evaluar el movimiento ocular utilizando videonistagmografía (VNG) y la prueba de impulso cefálico por vídeo (vHIT), y estudiar el perfil metabólico del lóbulo occipital en pacientes con migraña vestibular (VM). MATERIALES Y MÉTODOS: Se incluyeron dos grupos en el estudio; el primer grupo consistió en 25 pacientes con VM según los criterios recientes de la sociedad Bárány. El segundo grupo consistió en 20 sujetos sanos emparejados por edad. Ambos grupos se sometieron a lo siguiente: 1) Una historia detallada, protocolo de prueba de VNG y vHIT en 3 planos, y 2) Imágenes de resonancia magnética (IRM) para el cerebro y el oído interno con el imán de 1,5 tesla y la espectroscopía de resonancia magnética de protones (H1-MRS). RESULTADOS: El 68% de los pacientes se quejó de vértigo espontáneo, y el 28% de vértigo posicional. El nistagmo posicional no paroxístico se registró en el 60% de los pacientes durante su mareo. La resonancia magnética cerebral no mostró alteraciones en el 72% de los casos. El cambio químico en el lóbulo occipital se encontró en el 92% de los casos de VM. Los picos de lactato fueron estadísticamente significativos con relación a la presencia de nistagmo posicional no paroxístico. CONCLUSIONES: Existe una relación estadísticamente significativa entre el nistagmo posicional no paroxístico y la presencia de picos de lactato en el lóbulo occipital en pacientes con VM

Eye movements and imaging in vestibular migraine.

BACKGROUND AND OBJECTIVE: Migrainous dizziness is one of the most frequent complaints. Dizziness associated with migraine may be the result of abnormal eye movements. Brain imaging and changes in eye movements may explain the dizziness and highlight possible pathophysiological substrates in migraine dizziness. Our aim is to evaluate eye movement using videonystagmography (VNG) and video head impulse test (vHIT) and to study the occipital lobe metabolic profile in vestibular migraine patients (VM). MATERIALS AND METHODS: There were 2 groups enrolled in the study; the first group consisted of 25 vestibular migraine patients (VM) according to the recent criteria of Barany society. The second group consisted of 20 age matched healthy subjects. Both groups underwent the following: (1) A detailed history, VNG test protocol, vHIT in three planes. (2) Magnetic resonance imaging (MRI) for the brain and inner ear using 1.5T magnet and proton magnetic resonance spectroscopy (H1-MRS). RESULTS: Sixty eight percent of the patients complained of spontaneous vertigo and 28% complained of positional vertigo. Non-paroxysmal positional nystagmus was recorded in 92% during their dizzy spell. The brain MRI was unremarkable in 72% of the cases. Chemical shift in the occipital lobe was found in 92% of VM. Lactate peaks were statistically significant related with the presence of non-paroxysmal positional nystagmus. CONCLUSIONS: A statistically significant relationship exists between non-paroxysmal positional nystagmus and presence of lactate peaks in the occipital lobe in VM patients.

Video head impulse test (vHIT) in migraine dizziness.

BACKGROUND AND OBJECTIVE: Migraine is an extremely prevalent primary headache disorder that frequently associates parallel symptoms such as dizziness, tinnitus and hearing loss. Our aim is to investigate differences in video head impulse (vHIT) results with patients suffering from vestibular migraine (VM) and healthy people, taking into consideration mean values of vestibule ocular reflex (VOR) gain, occurrence of the compensatory saccades latency and amplitude. According to the results, determine the usefulness of vHIT in vestibular migraine diagnostics. METHODS: A total number of 120 subjects were enrolled in the study, 80 of them were vestibular migraine patients (VM), while the other 40 were a control group of age matched healthy subjects. History was taking during the evaluation; videonystagmography and the video head impulse test were done. RESULTS: The rate of saccades is much more higher in the VM group compared to the healthy subjects group, only 7.5% of the VM group showed a low VOR gain with compensatory saccades denoting a vestibular deficit. CONCLUSION: The refixation saccades are an important sign that could underlie different vestibular problems. vHIT result can contribute to the completion of full mosaic of vestibular migraine diagnostics.