Finally, while the presence of photophobia and phonophobia can sometimes be useful, they are non-specific, particularly in the acute stage of vertigo related to migraine. Additionally, most strokes caused by vertebral artery dissection and 14% of transient ischemic attacks (TIA) in the vertebrobasilar territories also present with headache, further complicating the differential diagnosis. However, in roughly half of patients with VM, the vestibular symptoms are not accompanied by headache. ![]() ![]() Despite this, the importance of differentiating CVD from VM is overlooked for a number of reasons.įirst, VM is thought to be easily differentiated from CVD based on a history that includes the presence of migraine headache and associated symptoms (i.e., photophobia and phonophobia). Therefore, the prompt differentiating of CVD from VM is a critical goal for clinicians. In addition to the expectation of a better clinical outcome, the differences in acute treatment and the long-term prophylaxis are completely different between migraine and dangerous central lesions. Although migraine is a pathophysiology involving the cortical regions that process vestibular afference, it is not considered as sinister as CVD. downbeat nystagmus instead of persistent horizontally directed nystagmus) is common in patients with VM, yet this finding, unfortunately, causes a majority of patients with VM to be diagnosed as having a CVD. Finally, low velocity nystagmus that does not follow the expected characteristics of a peripheral etiology (i.e. Abnormal ocular motor function has been reported in VM suggesting a central cause yet as many as 35% of patients with VM are unable to be classified as either having a central or peripheral origin. For example, although most head impulse testing is normal in patients with VM, patients with VM can have abnormal head impulse or abnormal caloric examination suggesting a peripheral cause. Despite the recently adopted clinical definition of VM, the clinical and oculographic evidence is varied. The current diagnostic criteria of VM are 1) episodes of recurrent spontaneous vertigo of moderate to severe degree, 2) personal history of migraine fulfilling the criteria of the International Headache Society (IHS), and 3) the accompaniment of migraine features during vertigo attacks. Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of VM are notoriously inconsistent and thus the diagnosis is difficult to confirm. VM is common and benign though regarded as a broad-spectrum central disorder. While numerous scientific articles have discussed how to differentiate CVD from peripheral vestibulopathy, few studies explore the differential diagnosis between dangerous CVD and vestibular migraine (VM). vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorder (CVD) from benign causes. ![]() The SVV bucket test is a useful clinical test to distinguish CVD from VM, particularly when interpreted along with the results of a focal neurological exam and clinical exam for nystagmus.Īmongst the most challenging diagnostic dilemmas, managing patients with vestibular symptoms (i.e. However, when we combined the SVV results with the clinical exam assessing gaze stability (nystagmus) with an abnormal focal neurological exam, the sensitivity (92.6%) and specificity (88.9%) were optimized (LR+ (8.3), LR- (0.08)). Using the bucket test alone to differentiate CVD from VM, sensitivity was 74.1%, specificity 91.7%, positive likelihood ratio (LR+) 8.9, and negative likelihood ratio (LR-) 0.3. The abnormal rate of SVV deviations (> 2.3°) in CVD was significantly higher than VM ( p < 0.001). Mean absolute SVV deviations measured by bucket testing in CVD and VM were 4.8 ± 4.1° and 0.7 ± 1.0°, respectively. Twenty-seven symptomatic patients diagnosed with CVD and 36 symptomatic patients with VM underwent brain imaging and clinical assessments including 1) SVV bucket test, 2) ABCD 2, 3) headache/vertigo history, 4) presence of focal neurological signs, 5) nystagmus, and 6) clinical head impulse testing. Here we conducted a prospective study investigating the sensitivity and specificity of combining standard vestibular and neurological examinations to determine how well central vestibular disorders (CVD) were distinguishable from vestibular migraine (VM). Migraine has long been recognized as one of the most common causes of vestibular symptoms, but the clinical hallmarks of vestibular migraine are notoriously inconsistent and thus the diagnosis is difficult to confirm. ![]() vertigo, nausea, imbalance) is differentiating dangerous central vestibular disorders from benign causes. Amongst the most challenging diagnostic dilemmas managing patients with vestibular symptoms (i.e.
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