The Ménière's Years (Part 8)
Ménière's and Stroke - Connection?
Introduction
Ménière's disease is generally defined as —
“an inner ear problem that can cause dizzy spells, also called vertigo, and hearing loss.” Mayo Clinic
“a balance disorder. It’s caused by an abnormality in part of the inner ear called the labyrinth. Fluid buildup here can cause a severe spinning feeling (vertigo) and affect the hearing.” John Hopkins Medicine
“a chronic inner ear disorder that leads to recurrent episodes of vertigo, hearing loss and tinnitus.” Cleveland Clinic
“a balance disorder. It’s caused by an abnormality in part of the inner ear called the labyrinth. Fluid buildup here can cause a severe spinning feeling (vertigo) and affect the hearing.” Vanderbilt Health
“a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear.” National Institute on Deafness and Other Communication Disorders
“a rare inner ear condition that can affect your balance and hearing.” UK National Health Service
“an inner ear disorder that causes fluctuating hearing loss, tinnitus, vertigo and fullness or pressure in the ear.” The House Institute
Most authoritative sources also add that the cause of Ménière's disease is unknown and currently incurable. Doctors who work with Ménière's patients (e.g. Otolaryngologists (ENT), Neurologists, and Neurotologists) often use a ‘ladder’ strategy when treating their patients. I addressed that process in a recent newsletter.
Stroke or TIA (Transient Ischemic Attack) is generally defined as —
“A stroke, sometimes called a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death.” Centers for Disease Control
“A stroke can occur when blood flow to the brain is blocked or there is sudden bleeding in the brain. There are two types of strokes. A stroke that occurs because blood flow to the brain is blocked is called an ischemic stroke. The brain cannot get oxygen and nutrients from the blood. Without oxygen and nutrients, brain cells begin to die within minutes. A stroke that occurs because of sudden bleeding in the brain is called a hemorrhagic stroke. The leaked blood results in pressure on brain cells, damaging them.” NIH, National Heart, Lung, and Blood Institute
“In medicine, a loss of blood flow to part of the brain, which damages brain tissue. Strokes are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language. The risk of stroke is increased by high blood pressure, older age, smoking, diabetes, high cholesterol, heart disease, atherosclerosis (a buildup of fatty material and plaque inside the coronary arteries), and a family history of stroke. Also called cerebrovascular accident and CVA.” National Cancer Institute
“An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked or "clogged" and impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen and nutrients.” John Hopkins Medicine
Is There A Connection Between Ménière's And Stroke?
I ask that question because many people I’ve known through the years (including myself) have experienced a stroke or TIA. The answer I’ve received from many experts is — ‘no, it does not.’ Looking at lists of conditions (factors) that can lead to an ischemic stroke (e.g. Mayo Clinic, Cleveland Clinic, CDC, NIH National Institute on Aging), I do not see Ménière's disease mentioned as a ‘factor’ that might lead to a TIA.
I communicated with several Ménière's patients who had also had TIAs. Most of them never went to the hospital and said the TIA lasted only a brief time and didn’t cause them any ongoing problems. Only a few went to the ER to see what was happening. Only one said he lost consciousness for a period of several hours and was treated in ICU. Some Ménière's patients said they fell and hit their head and were told that may have led to artery damage and a ‘brain stem stroke.’
Vertigo
One of the neurologists who saw me in the hospital after my TIA was very interested in my experience with Ménière's disease — especially what triggered my ‘vertigo attacks.’ That led me to search for a connection between vertigo and stroke and I found some interesting studies online. One of them is titled, Missed Stroke in Acute Vertigo and Dizziness: It is Time for Action, not Debate. It’s available at the National Library of Medicine. It’s a lengthy article and includes many citations.
I’m not saying that ‘vertigo’ or hitting your head after a fall can lead to a TIA. I’m a journalist, not a doctor. I ask questions and search for answers by going to reliable sources. Two I use for this type of health research are the American Heart Association and the American Stroke Association. What I found on their websites about vertigo and stroke were intriguing—
"Vertigo patients are at higher risk for stroke than the general population. They should have a comprehensive neurological examination, vascular risk factors survey, and regular follow-up for several years after hospital discharge after treatment of isolated vertigo." AHA/ASA Journals
Here’s another article from the American Heart Association titled, Acute Transient Vestibular Syndrome: Prevalence of Stroke and Efficacy of Bedside Evaluation.
“Acute vestibular syndrome is characterized by rapid onset of vertigo, nausea/vomiting, and gait unsteadiness in association with head motion intolerance and nystagmus lasting days to weeks. The HINTS (negative head impulse, nystagmus pattern, test of skew) has been proved to be useful in identifying strokes in acute vestibular syndrome. A recent study also showed that the combination of ABCD score (age, blood pressure, clinical features, duration, and diabetes mellitus), general neurological examination, and specialized oculomotor evaluation can stratify the risk of acute stroke in acute dizziness. However, many patients develop acute transient dizziness and vertigo lasting <1 day, which may be termed acute transient vestibular syndrome (ATVS). Even though the National Institute of Neurological Disorders and Stroke III classification does not consider isolated vertigo as a symptom of transient ischemic attack (TIA) involving the vertebrobasilar territory (VB-TIA), ATVS may occur in VB-TIA. Indeed, isolated vertigo was the only manifestation in 21% of patients diagnosed with VB-TIA, and 62% of the patients with vertigo because of VB-TIA had a history of isolated episodic vertigo Furthermore, recent studies reported that preceding transient isolated brainstem symptoms are common in patients with a completed stroke in the vertebrobasilar territory. Diffusion-weighted imaging (DWI) provides evidence of acute infarction in one third of the patients with TIA and in 23% of the patients with a clinical diagnosis of a transient neurological attack.” American Heart Association
You may also find this National Library of Medicine study of interest as well — Stroke Among Patients With Dizziness, Vertigo, and Imbalance in the Emergency Department: A Population-Based Study.
Both medical reports are detailed with many references to help you look further into the issue.
Because some Ménière's patients mentioned ‘falling,' I found this article interesting:
While vertigo is often related to inner ear issues, it can also occur in patients presenting with transient ischemic attack or stroke due to compromised blood flow. Syncope occurs when there is insufficient blood flow to the brain, leading to fainting. Additionally, cerebral hypoperfusion can also lead to dizziness when blood flow to the brain is compromised. Avicenna Cardiology
I found this article from the University of Colorado in Denver interesting:
“Researchers at University of Colorado School of Medicine may have figured out what causes Meniere's disease and how to attack it. According to Carol Foster, MD, from the department of otolaryngology and Robert Breeze, MD, a neurosurgeon, there is a strong association between Meniere's disease and conditions involving temporary low blood flow in the brain such as migraine headaches.
"If our hypothesis is confirmed, treatment of vascular risk factors may allow control of symptoms and result in a decreased need for surgeries that destroy the balance function in order to control the spell" said Foster.
"If attacks are controlled, the previously inevitable progression to severe hearing loss may be preventable in some cases."
Foster explains that these attacks can be caused by a combination of two factors: 1) a malformation of the inner ear, endolymphatic hydrops (the inner ear dilated with fluid) and 2) risk factors for vascular disease in the brain, such as migraine, sleep apnea, smoking and atherosclerosis.
The researchers propose that a fluid buildup in part of the inner ear, which is strongly associated with Meniere attacks, indicates the presence of a pressure-regulation problem that acts to cause mild, intermittent decreases of blood flow within the ear.
When this is combined with vascular diseases that also lower blood flow to the brain and ear, sudden loss of blood flow similar to transient ischemic attacks (or mini strokes) in the brain can be generated in the inner ear sensory tissues.” Science Daily
Questions
One of the things I learned as an investigative reporter and researcher was that asking questions doesn’t always doesn’t lead to all the answers I’d like to have available for my story. That’s the way I feel about asking the first question; whether Ménière's has some connection to TIAs. Based on my research so far, I think a person with Ménière's who also has other medical issues may be more susceptible to a TIA (e.g. stress, anxiety, hypertension, etc). I still have other questions yet to be answered and will address some of those in the next ‘Ménière's Years ‘ newsletter.
More References
The cardiovascular aspects of a Ménière's disease population – A pilot study
The Clinical Differentiation of Cerebellar Infarction from Common Vertigo Syndromes
Menière's disease in the elderly
How to Distinguish Between a Stroke and Vertigo
Neurological Red Flags: A Missed Stroke after Intermittent Episodes of Dizziness and Headache
Brainstem strokes associated with vertigo or hearing symptoms
Signs and Symptoms of Meniere's Disease
“… rejoicing in hope, patient in tribulation, continuing steadfastly in prayer.” Romans 12:12
Here’s to hope!
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