Vestibular migraine: epidemiology, pathogenesis, clinical picture, diagnosis and treatment

The spectrum of diseases manifested by positional vertigo includes benign paroxysmal positional vertigo (BPPV), vestibular migraine, brain tumors, demyelinating and some other diseases.Objective: to study the common practice of managing patients with positional vertigo.Material and methods. 64 patients with complaints of positional vertigo were examined. Clinical and neurological examination, otoneurological examination, including positional diagnostic tests, assessment of spontaneous nystagmus in Frenzel video glasses, tests of smooth tracking, saccades, head shaking, Fukuda test were carried out.Results. In the majority (70%) of cases, the referral diagnoses for vertigo were chronic cerebral ischemia, vertebral artery syndrome, and vegetative-vascular dystonia. However, none of these diagnoses was confirmed as the leading cause of vertigo. The most common mistake (62.5%) was making a diagnosis only on the basis of complaints, without an otoneurological examination and positional tests. The most common causes of vertigo were BPPV (64.6%), vestibular migraine (20.3%) and vestibular neuronitis (12.5%).Conclusion. In the diagnosis of positional vertigo, the evaluation of clinical manifestations, otoneurological tests and characteristics of positional nystagmus plays a leading role.

Managing patients with positional vertigo: diagnostic pitfalls and treatment

Lavrik,

Borisov,

Shprakh

et al. 2023

Modern concept of vascular vertigo

Zhiznevskiy

Замерград

Grachev

2023

Among the various causes of acute vestibular vertigo, vascular factors are of particular importance. Numerous studies show that the diagnosis of vascular vertigo remains inadequate, often leading to overdiagnosis of stroke and transient ischemic attacks in patients with peripheral vestibular disorders and vestibular migraine, on the one hand, and underestimation of the importance of cerebrovascular pathology, especially in patients with the first attack of persistent vestibular vertigo, on the other.The International Barany Society has developed and published diagnostic criteria for vascular vertigo. These criteria are intended to facilitate the identification of vascular causes of acute vestibular syndrome. Particular emphasis is placed on clinical signs because imaging techniques often do not allow detection of foci small in volume and area, especially in cases when stroke is manifested by an isolated vestibular syndrome. Key clinical signs to analyze when a vascular etiology of acute vestibular syndrome is suspected include nystagmus, corrective saccades on the Halmagyi test, smooth visual pursuit, visual saccades, severity of trunk ataxia, and hearing loss.

Differential diagnosis of ischemic stroke in the arteries of the vertebrobasilar system

Kulesh,

Demin,

Vinogradov

2023

Self Cite

Stroke in the arteries of the vertebrobasilar system is characterized by a variety of nonspecific symptoms, many mimickers, and often atypical clinical presentation, which, together with the low sensitivity of CT and MRI of the brain, leads to incorrect and untimely diagnosis. This article addresses in detail the issues of differential diagnosis of this disease with Guillain–Barre syndrome, myasthenic crisis, central pontine myelinolysis, multiple sclerosis, Wernicke encephalopathy, vestibular neuronitis, Meniere's disease, and vestibular migraine.