Gadolinium-enhanced MRI may differentiate Meniere's disease from vestibular migraine

New research revealed that Gadolinium-enhanced MRI of the inner ear differentiates Meniere's disease (MD) and vestibular migraine (VM) as per a study that was published in the journal The Laryngoscope. 

Differentiating Vestibular migraine and Meniere's disease clinically is difficult. Vestibular migraine is defined as having a moderate intensity of vestibular symptoms, current or past history of migraine, and migraine symptoms during at least two vertigo attacks. MD is a consequence of overaccumulation of endolymph in the inner ear, which occurs at the expense of the perilymphatic space. As there are no definitive diagnostic criteria to distinguish the two conditions, researchers conducted a study to explore the predictive factors between Meniere's disease (MD) and vestibular migraine (VM) by Gadolinium-enhanced Magnetic resonance imaging (MRI) of the inner ear and Clinical Features. 

Eighty-seven patients (50 MD and 37 VM) who were given an intratympanic gadolinium injection underwent MRI 24 h later. All patients underwent pure tone audiometry and caloric tests. 

Key findings:

• In the MD group, 46 (92%) of 50 patients developed endolymphatic hydrops, although only 2 (5.4%) in the vestibular migraine (VM) group had positive results groups (p < 0.001).
• The incidence of migraine was 14% in the MD group and 67.7% in the VM group (p < 0.001).
• Multivariate logistic regression of the two groups of patients indicated that the greater the sum of the maximum slow phase velocity (SPV) of the ipsilateral ear, the higher the risk of VM occurrence (p = 0.009).
• The incidence of carsickness was positively correlated with the incidence of VM, and asymmetric hearing loss (AHL) was negatively correlated with the diagnosis of VM (p = 0.045). 

Thus, though carsickness, decreased AHL, and increased sum of the maximum SPV in the ipsilateral side (SSPVI) may act as diagnostic predictors of VM, Gadolinium-enhanced MRI of the inner ear differentiates vestibular migraine from Meniere's disease.