Recurrent vestibulopathy: are cVEMP, oVEMP and inner ear MRI useful to distinguish patients with Meniere's disease and vestibular migraine?

Purpose The aim of this study was to assess the rate of endolymphatic hydrops (EH) on MRI and the rate of otolithic dysfunction with cVEMP and oVEMP, in patients with recurrent vertigo such as Meniere's disease (MD), vestibular migraine (VM) and vestibular Meniere's disease (vMD). Methods In this retrospective study, we performed 3D-FLAIR sequences with delayed acquisition in 20 MD, 20 VM and 20 vMD patients. Each subject was then assessed for the presence of EH on MRI. All patients underwent pure-tone audiometry, cVEMP and oVEMP. Results In MD patients, EH was observed in 18 (90%) out of 20 patients while EH was observed in only 1 MV (5%) and 1 vMD (5%) patients. We found significant differences between groups for the presence of EH on MRI (p = 0.001). MD patients had significant higher PTA level (p < 0.001) and oVEMP impairment than MV and vMD (p = 0.08 and p = 0.06, respectively). However, no significant differences were observed for cVEMP impairment, either asymmetric ratio (p = 0.36) and 1000/500 ratio (p = 0.20). Conclusions Concerning cVEMP, we observed no significant differences between VM, vMD and MD. However, we observed higher oVEMP impairment, PTA level and EH on MRI in MD patients. We believe that MRI could be used to differentiate MD from VM patients with cochlear symptoms. However, in cases of migraine associated with recurrent vertigo and without cochlear symptoms, we believe that MRI is not a useful tool to differentiate between VM and vMD.

Automated summary

For MD patients, EH was observed in 18 out of 20 patients while only 1 patient each in the MV and vMD groups showed EH. Significant differences were found between groups in terms of EH on MRI (p = 0.001). MD patients had significantly higher PTA levels and oVEMP impairments compared to MV and vMD patients. However, no significant differences were observed in cVEMP impairments, asymmetric ratios, or 1000/500 ratios.