الفهرس 
INTRODUCTION AND RATIONALEOnly 14 pages are availabe for public view
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Abstract
SUMMARY
igrinous vertigo (MV) is one of the most common causes of episodic vertigo and is increasingly recognized among neurologist and migraine specialist (Chen and Young, 2003).
Recently the characteristics and the diagnostic values of oVEMP testing have been investigated in migrainous vertigo patients. However, those studies were few and rarely attempted to correlate with other vestibular tests. Accordingly, this work was designed to evaluate both cVEMP and oVEMP in MV patients and try to correlate them with their vestibular office tests findings.
This study was conducted on twenty patients complaining of vestibular migraine (VM) (18 females, 2 males), their mean age was 36.9 (±12.9) years (range 18-62years).They were selected according to the criteria of HIS, Beta (2013). Age and gender matched control group consisted of twenty subjects with no history of intense headache or vertigo were examined
Methodology
All subjects were submitted to
1- Detailed history with particular emphasis on migrainous and vertiginous
M
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2- Pure-tone and speech Audiometry using Interacoustics audiometer model AC 40. Middle ear functions were assessed using Madsen tympanometry model Zodiac 901
3- Vestibular evaluation included clinical vestibular office testing and vestibular evoked myogenic potentials (cVEMPs and oVEMP)
A- Clinical office test battery included: Occulomotor tests (Range of eye movement, gaze, Smooth pursuit and Saccadic Tests); vestibulo-ocular reflex tests (search for spontaneous Nystagmus, Head shake Test and Head thrust Test (HTT); positional and positioning Dix-Hallpike test; Vestibulo- spinal reflex tests (ModifiedCTSIB,-Fukuda Test and Tandem walk).
B- Vestibular evoked myogenic potentials
Both AC oVEMPs and AC cVEMPs were examined using Evoked potential measuring System Biologic Navigator Pro V
Results:
Despite of the majority of VM patients had normal hearing, some of them experienced migrinous attack ear fullness, distressing tinnitus and or phonophobia during or following
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True vertigo was experienced in 60% of patients while 40% patients had unsteadiness sense (transient imbalance). Vestibular episodes ranged from seconds up to 48 hours. Episodes lasting for hours were more frequent in 55% of patients.
Among 20 VM patients, 5 patients (25%) had normal cVEMP response. Abnormal cVEMP was found in 15 subjects (75%). While the majority of VM patients (no=19 ’95%’) had abnormal oVEMP response. Abnormal response is either absent, delayed response or diminished amplitude Abnormal response was unilateral or bilateral.
Vestibular Office Tests showed normal occulomotor tests, vestibulo-ocular reflex tests, positional and positioning Dix-Hallpike tests were normal in all patients. However, Vestibulo- spinal reflex tests were abnormal in 25% of patients.
There was statistically insignificant correlation between age of patients, duration of migraine, duration of dizziness and both cVEMP and oVEMP response parameters (latencies and amplitude).
However, there was significant positive correlation between abnormal Fukuda, modified CTSIB, tandem gait tests with both cVEMP and oVEMP abnormality.
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Conclusions
In the current study the main abnormality were bilateral, prolonged latency and reduced amplitude in VM patients affecting both oVEMP and cVEMP. Those are two different pathways (VOR and VSR), but they share in having pathway through auditory brainstem, that may lead to suggestion that VM patient have central rather than peripheral vestibular dysfunction.
Abnormal cVEMP and oVEMP parameters were significantly correlated with abnormal VSR office tests. Especially in patients who had bilateral cVEMP and oVEMP affection. This may reflect that VSR abnormalities might be detected clinically among those with more severe affection.