Sudden Onset of Vestibular Migraine Complicated with BPPV and Mal de Debarquement Syndrome – a Diagnostic Dilemma
https://doi.org/10.14412/2074-2711-2021-6-139-141
Abstract
Vestibular migraine is combination of migraine and vestibular symptoms. In clinical examination it can be replaced with benign paroxysmal positional vertigo (BPPV) cupulolithiasis, but also BPPV is common comorbidity in migraine patients. There is also high association between vestibular migraine and Mal de Debarquement syndrome. Patient came to hospital with vertigo that was diagnosed as left PC-BPPV canalolithiasis. After first Epley's maneuver symptoms didn't resolved. Week after, at second Epley's maneuver performed patient developed left PC-BPPV cupulolithiasis. Month after, at third Epley's maneuver BPPV resolved but patient developed Mal de Debarquement syndrome. Laboratory testing showed hyperhomocisteinemia and homozygous MTHFR C677T and PAI, with low vitamin D. After reviewing the vestibular symptoms in the first attack which was misdiagnosed as BPPV canalolithiasis, and history of migraine, patient was diagnosed with vestibular migraine. Patient well responded to migraine diet and supplementation with B complex. Vestibular disorders are similar to each other and they can overlap. More attention in taking detailed medical history should be given to patients with vertigo or dizziness.
About the Authors
R. Perkoviс
Department of Neurology, J.J. Strossmayer University, Osijek University Hospital Centre
Croatia
Croatia
Trg Svetog Trojstva 3, 31000, Osijek, Croatia
S. Maslovara
Department of Otorhinolaryngology, Vukovar County General Hospital;
Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, J.J. Strossmayer University
Croatia
Croatia
Zupanijska 35, 32000, Vukovar, Croatia
Trg Svetog Trojstva 3, 31000, Osijek, Croatia
K. Kovaсeviс′ Stranski
Department of Rheumatology, Imunology and Allergology, J.J. Strossmayer University, Osijek University Hospital Centre
Croatia
Croatia
Trg Svetog Trojstva 3, 31000, Osijek, Croatia
K. Buljan
Department of Neurology, J.J. Strossmayer University, Osijek University Hospital Centre
Croatia
Croatia
Trg Svetog Trojstva 3, 31000, Osijek, Croatia
S. Tomiс′
Department of Neurology, J.J. Strossmayer University, Osijek University Hospital Centre
Croatia
Croatia
Trg Svetog Trojstva 3, 31000, Osijek, Croatia
S. Juriс′
Department of Neurology, J.J. Strossmayer University, Osijek University Hospital Centre
Croatia
Croatia
Trg Svetog Trojstva 3, 31000, Osijek, Croatia
References
1. Dieterich M, Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine? J Neurol. 1999 Oct;246(10):883-92. doi: 10.1007/s004150050478
2. Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia. 2004 Feb;24(2):83-91. doi: 10.1111/j.1468-2982.2004.00662.x
3. Von Brevern M, Zeise D, Neuhauser H, et al. Acute migrainous vertigo: clinical and oculographic findings. Brain. 2005 Feb;128(Pt 2):365-74. doi: 10.1093/brain/awh351. Epub 2004 Dec 15.
4. Polensek SH, Tusa RJ. Nystagmus during attacks of vestibular migraine: an aid in diagnosis. Audiol Neurotol. 2010;15(4):241-6. doi: 10.1159/000255440. Epub 2009 Nov 5.
5. Ishiyama A, Jacobson KM, Baloh RW. Migraine and benign positional vertigo. Ann Otol Phinol Laryngol. 2000 Apr;109(4):377-80. doi: 10.1177/000348940010900407
6. Chu C-H, Liu C-J, Lin L-Y, et al. Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. J Headache Pain. 2015;16:62. doi: 10.1186/s10194-015-0547-z. Epub 2015 Jul 4.
7. MacKe A, LePorte A, Clark BC. Social, societal, and economic burden of mal de debarquement syndrome. J Neurol. 2012 Jul;259(7):1326-30. doi: 10.1007/s00415-011-6349-6. Epub 2012 Jan 10.
8. Van Ombergen A, van Rompaey V, Maes LK, et al. Mal De debarquement syndrome: a systematic review. J Neurol. 2016 May;263(5):843-54. doi: 10.1007/s00415-015-7962-6. Epub 2015 Nov 11.
9. Cha YH, Brodsky J, Ishiyama G, et al. Clinical features and associated syndromes of mal de debarquement. J Neurol. 2008 Jul;255(7):1038-44. doi: 10.1007/s00415-008-0837-3. Epub 2008 May 30.
10. Cha Y-H, Baloh RW, Cho C, et al. Mal de debarquement syndrome diagnostic criteria: Consensus document of the Classification Committee of the Barany Society. J Vestibul Res. 2020;30(5):285-93. doi: 10.3233/VES-200714
11. Beh SC, Chiang H-S, Sanderson C. The Interconnections of Mal de Debarquement Syndrome and Vestibular Migraine. Laryngoscope. 2021 May;131(5):E1653-E1661. doi: 10.1002/lary.29214. Epub 2020 Nov 2.
12. McCully KS. Homocysteine, vitamins, and vascular disease prevention. Am J Clin Nutr. 2007 Nov;86(5):1563S-8S. doi: 10.1093/ajcn/86.5.1563S
13. Lea R, Colson N, Quinlan S, et al. The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability. Pharmacogenet Genomics. 2009 Jun;19(6):422-8. doi: 10.1097/FPC.0b013e32832af5a3
14. Menon S, Lea RA, Roy B, et al. Genotypes of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine disability in response to vitamin supplementation. Pharmacogenet Genomics. 2012 Oct;22(10):741-9. doi: 10.1097/FPC.0b013e3283576b6b
Review
For citations:
Perkoviс R, Maslovara S, Kovaсeviс′ Stranski K, Buljan K, Tomiс′ S, Juriс′ S. Sudden Onset of Vestibular Migraine Complicated with BPPV and Mal de Debarquement Syndrome – a Diagnostic Dilemma. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(6):139-141. https://doi.org/10.14412/2074-2711-2021-6-139-141
Views:
1214
Email this article 