ABSTRACT
RESUMEN La compresión vascular del nervio vestíbulo-coclear puede manifestarse con una sintomatología variada, incluyendo el vértigo, cuya causa, poco frecuente, son las asas vasculares. Se presenta el caso de un paciente del sexo masculino de 41 años, quien acudió a consulta en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, por presentar hipoacusia y acufenos del oído izquierdo, además vértigos. Se realizó una resonancia magnética simple que mostró un asa vascular en la arteria cerebelosa inferior anterior que ingresaba al conducto auditivo interno, lo cual explicaba la sintomatología. El paciente tuvo mejoría clínica después de tratamiento sintomático. Por lo poco común de la entidad se decidió la presentación del caso.
ABSTRACT Vascular compression of the vestibule-cochlear nerve can manifest itself with a variety of symptoms, including vertigo, the cause of which is infrequent by vascular loops. We present the case of a 41-year-old male patient who came to the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos for hearing loss and tinnitus in the left ear, as well as dizziness. A simple MRI was performed that showed a vascular loop in the anterior inferior cerebellar artery that entered the internal auditory canal, which explained the symptoms. The patient had clinical improvement after symptomatic treatment. Due to the unusual nature of the entity, the presentation of the case was decided.
ABSTRACT
Objective: To investigate the value of high-resolution CT (HRCT) combined with MR T2-DRIVE in diagnosis of cochlear nerve dysplasia (CND) of children. Methods: HRCT and MR T2-DRIVE image data of 43 children (28 unilateral and 15 bilateral) with CND were retrospectively analyzed. The diameters of cochlear nerve canal (CNC) and cochlear nerve were measured with HRCT and T2-DRIVE,respectively. The correlation between CNC diameter and cochlear nerve diameter was analyzed by using Spearman correlation. Results: A total of 58 diseased ears, including 27 pure CND ears and 31 CND accompanied with malformation of inner ear ones, as well as 28 normal ears were found among 43 CND children. HRCT showed CNN stenosis in 45 ears, CNC atresia or absence in 13 ears, internal auditory canal stenosis in 15 ears, including CNC stenosis 12 ears, CNC atresia 2 ears and CNN absence 1 ear. MRI showed abnormal facial nerve morphology in 7 ears, vestibular nerve absence in 1 ear and slender in 1 ear. Among 15 ears of internal auditory canal stenosis, vestibulocochlear nerve was absence in 8 ears and slender in 3 ears, while was normal in 4 ears. Among 58 diseased ears, CNC was demonstrated normal on both HRCT and MRI in 7 ears. The diameters of CNC and cochlear nerve of CND ears were all smaller than those of normal ears (both P=0.001), while no statistically difference of diameters of CNC and cochlear nerve between pure CND ears and CND accompanied with malformation of inner ear ones (P=0.185, 0.140). CNC diameter of all 86 ears was positively correlated with diameter of cochlear nerve (rs=0.773, P<0.001). Taken CNC diameter=1.5 mm as cut-off value, the sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of CND was 84.48% (49/58), 100% (28/28), 100% (49/49) and 75.68% (28/37), respectively. Conclusion: HRCT combined with MR T2-DRIVE can provide diagnostic references for CND of children.
ABSTRACT
Abstract Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity. Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review. Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is themost certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.
ABSTRACT
The incidence of human immunodeficiency virus (HIV) infections continue to increase throughout the world. Although neurologic complications are frequent in individuals with HIV infection or acquired immunodeficiency syndrome (AIDS), vestibulocochlear neuritis is still a relatively rare manifestation. We report the first case of vestibulocochlear neuritis occurring in an AIDS patient in Korea.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome , Hearing Loss , HIV , HIV Infections , Incidence , Korea , Neuritis , Vestibulocochlear Nerve DiseasesABSTRACT
Introducción: El vértigo es un motivo frecuente de consulta en los servicio de urgencias, por lo tanto es primordial para iniciar un tratamiento adecuado diferenciar un origen periférico de uno central. La historia clínica y la exploración neurológica completa son fundamentales para llegar a un diagnóstico, ya que las pruebas de imagen tienen una baja sensibilidad en la fase aguda y no siempre están disponibles en los servicios de urgencias. Objetivo: Presentar el caso clínico de una paciente de 74 años con vértigo agudo que sugiere inicialmente un origen periférico, pero que se debe a un infarto cerebeloso. Diseño: Reporte de caso. Materiales y métodos: Se presenta el caso de una paciente de 74 años que acude a urgencias por presentar de manera súbita vértigo objetivo con los movimientos cefálicos, intenso cortejo vegetativo, sin síntomas otológicos, con factores de riesgo cardiovascular importantes; al examen físico nistagmo horizontal derecho, no agotable, dismetría, disdiadococinesia izquierda e inestabilidad marcada que le impide la bipedestación. En tomografía craneal, se observa hipodensidad en región superior del hemisferio cerebeloso izquierdo sugestiva de lesión isquémica aguda en territorio vascular de la arteria cerebelosa superior. Resultados: Se diagnosticó mediante resonancia magnética nuclear, infarto isquémico en fase subaguda en el territorio de arteria cerebelosa superior izquierda. Conclusiones: Es importante diferenciar el vértigo aislado por causa vascular de trastornos más benignos que se relacionan con el oído interno, ya que la estrategia terapéutica y el pronóstico difieren considerablemente
Introduction: Vertigo is a frequent reason for consultation in the emergency department, therefore it is essential to differentiate between peripheral and central origin to initiate a suitable treatment. The clinical history and neurological examination are essential to reach a diagnosis, because imaging tests have low sensitivity in the acute phase and are not always available in the Emergency Department. Objective: To present the clinical case of a 74 year old patient with acute vertigo which initially suggested a peripheral origin, but it was due to an acute cerebellar infarction. Design: Case report. Materials and methods: We present the case of a patient of 74 years who came to the emergency department because of a sudden objective vertigo with was presented with head movements, severe vegetative symptoms without otologic symptoms. Important cardiovascular risk factors was identified; physical examination revealed an inexhaustible, horizontal, right nistagmus; dysmetria, left dysdiadochokinesia and marked instability. In tomography, a suggestive image of acute ischemic injury in vascular territory of the superior cerebellar artery hemisphere was seen. Results: A subacute ischemic stroke in the territory of the left superior cerebellar artery was diagnosed by nuclear magnetic resonance. Conclusions: It is important to differentiate isolated vertigo caused by more benign inner ear disease from those caused by vascular disorders, since therapeutic strategy and prognosis differ considerably.
Subject(s)
Vestibulocochlear Nerve Diseases , Central Nervous System , StrokeABSTRACT
BACKGROUND AND OBJECTIVES: Etiology of acute unilateral peripheral vestibulopathy (AUPV) includes virus, ischemia, and autoimmune. As anatomical distribution is similar between vasculature and innervation, AUPV with vascular risk factors could be ischemic origin. We investigated the pattern of audiovestibular dysfunction to explore the influence of risk factors on AUPV. MATERIALS AND METHODS: We collected records of 162 AUPV patients from 2011 to 2013 who were admitted within 7 days from vertigo onset and diagnosed as AUPV by caloric test and neuro-otologic examination. Vascular risk factors are stroke history, hypertension, diabetes, body mass index >25, age >60, and vertebrobasilar stenosis. Bedside examination includes spontaneous nystagmus grade, head impulse test, head shaking test. Results of rotatory chair test (n=125), caloric test (n=162), cervical (n=33) and ocular (n=23) vestibular evoked myogenic potential (VEMP), subjective visual vertical (SVV) (n=91), and pure tone audiometry (PTA) (n=62) are collected. RESULTS: Abnormalities of PTA are found more in patients with vascular risk factor than without any risk factor. Specifically, hypertension (p=0.008) and old age (p=0.025) are associated with PTA abnormality (p=0.006). Tilt angle of vertical is larger in risk factor group (p=0.019). The number of vascular risk factor correlates with abnormalities of PTA (p=0.025) and tilt angle of SVV. Results of bedside examination, rotatory chair test, caloric test, cervical and ocular VEMP are not associated with vascular risk factors. CONCLUSION: AUPV patients with vascular risk factors have more extensive involvement of audiovestibular function. Ischemic etiology may contribute to pathogenesis of extensive AUPV.
Subject(s)
Humans , Audiometry , Body Mass Index , Caloric Tests , Constriction, Pathologic , Head , Head Impulse Test , Hypertension , Ischemia , Risk Factors , Stroke , Vertigo , Vestibular Neuronitis , Vestibulocochlear Nerve DiseasesABSTRACT
Introduction: Acoustic nerve tumors have been recognized as a clinico-pathologic entity for at least 200 years, and they represent 90% of cerebellopontine angle diseases. Histologically, the tumors are derived from Schwann cells of the myelin sheath, with smaller tumors consisting of elongated palisade cells, while in large tumors, cystic degeneration can be found in the central areas, possibly due to deficient vascularization. We retrospectively reviewed 825 cases of vestibular schwannomas, reported between January 1984 and August 2006, in which the patients underwent surgery to remove the tumor. Objective: To evaluate signs, symptoms, aspects of clinical diagnosis, including the results of audiological and imaging studies, and surgical techniques and complications. Methods: A retrospective chart review. The medical records of all patients undergoing surgical treatment for schwannoma during the period indicated were reviewed. Results and Conclusion: Hearing loss was the first symptom reported in almost all cases, and tumor size was not proportional to the impairment of the auditory threshold. The surgical techniques allowed safe preservation of facial function. In particular, the retrolabyrinthine route proved useful in small tumors, with 50% preservation of hearing...
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Middle Aged , Audiometry, Evoked Response , Audiometry, Speech , Skull Neoplasms/diagnosis , Skull Neoplasms/pathology , Vestibulocochlear Nerve/pathology , Neuroma, Acoustic/etiology , Neuroma, Acoustic/pathologyABSTRACT
Objetivos: Describir los hallazgos por imagen en tomografía computarizada (TAC ) y resonancia magnética (RM) en una paciente con estenosis del CAI. Describir el desarrollo embriológico de las estructuras del CAI y la historia natural de la estenosis del CAI . Métodos: Se presenta el caso de una paciente de 4 años de edad con diagnóstico de cardiopatía congénita, hipoacusia neurosensorial (HNS ) y otitis media recurrente bilateral, y a quien se realizó TAC del hueso temporal con imágenes axiales y reconstrucciones coronales, en las cuales se observa disminución del diámetro de la luz del CAI izquierdo (menor de 2 mm), ausencia del CAI derecho y estructuras del oído interno de características normales, compatibles con estenosis del CAI izquierdo. Las imágenes de RM demuestran la estenosis del CAI izquierdo, sin observarse las estructuras nerviosas dentro de éste, compatible con hipoplasia/aplasia del nervio vestibulococlear. Resultados: Se describen brevemente la patología, el origen embriológico y la importancia de la asociación de la estenosis delCAI a hipoplasia/aplasia del nervio vestibulococlear en el diagnóstico diferencial de las causas de HNS , que contraindican la realización de implante coclear. Conclusiones: La estenosis del CAI e hipoplasia/aplasia del nervio vestibulococlear es un diagnóstico para tener en cuenta dentro de las causas de HNS , y su diagnóstico puede realizarse a través de TAC y de RM.
Objectives: To describe the computed tomography (CT) and magnetic resonance (MR) findings in a patient with a diagnosis of internal auditory canal (IAC) stenosis. To describe the embryological development of the IAC structures and the natural history of IAC stenosis. Methods: A 4 year old girl presents with sensorineural hearing loss and bilateral recurrent otitis media. The temporal bone CT shows diminished left IAC diameter (less than 2 mm),right IAC absence and normal inner ear structures. These findings are pathognomonic for left IAC stenosis. The MR findings include left IAC stenosis and IAC neural structures absence secondary to aplasia of the vestibulocochlear nerve on each IAC . Results: Hypoplasia/aplasia of the vestibulocochlear nerve in association with IAC stenosis is an important consideration in the differential diagnosis of sensorineural hearing loss, as it is a relative contraindication for cochlear implant placement. Conclusions: IAC stenosis and vestibulocochlear nerve hypoplasia/aplasia must be excluded as an etiology of sensorineural hearing loss. The diagnosis can be made by CT and MR.
Subject(s)
Humans , Hearing Loss, Sensorineural , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
Os agrotóxicos são amplamente utilizados no meio rural e sua larga utilização, desprovida de medidas de biossegurança apropriadas, vem provocando impactos potenciais tanto para a degradação ambiental quanto para o organismo humano, aumentando a incidência de intoxicações ocupacionais. O objetivo do presente estudo foi revisar e discutir a respeito da exposição aos agrotóxicos e sua influência na função e estrutura do sistema auditivo. Foram revisados periódicos nacionais e internacionais relevantes indexados no PubMed, Medline, Bireme e LILACS, assim como capítulos de livros e dissertações publicados no período entre 1987 e 2009. As pesquisas sugerem que a exposição, principalmente crônica, aos agrotóxicos induz a alterações funcionais no sistema vestibulococlear, manifestando ainda uma série de sinais e sintomas. Apesar da escassez de dados sobre a influência do organofosforado nas características morfológicas do aparelho auditivo, os estudos indicam que a exposição de caráter agudo aos agrotóxicos pode também ser responsável por alterações no sistema auditivo, caracterizadas por lesões estruturais na cóclea, principalmente nas células ciliadas externas.
Pesticides are widely used in agriculture, and the widespread application of these agents, without the appropriate use of bio-security measures, has been causing potential impacts for environmental degradation, as well as for the human organism, increasing the incidence of occupational poisoning. The aim of the present study was to review the available literature and to carry out a discussion regarding pesticides exposure and its harmful effects on the auditory system's function and structure. Relevant national and international journals indexed in PubMed, Medline, Bireme and LILACS were reviewed, as well as book chapters and dissertations published between 1987 and 2009. The available data suggest that chronic exposure to pesticides lead to functional alterations in the vestibulocochlear system, as well as a series of signs and symptoms. In spite of the scarce data describing organophosphorus influence on morphological characteristics of the auditory system, the literature suggest that acute exposure to pesticides can also be responsible for auditory system alterations, characterized by structural lesions in the cochlea, mainly in outer hair cells.
Subject(s)
Humans , Insecticides, Organophosphate/adverse effects , Pesticide Exposure , Vestibulocochlear Nerve Diseases , Vestibule, Labyrinth/injuriesABSTRACT
OBJECTIVE To study the causes and mechanism of auditory neuropathy. METHODS Auditory neuropathy is characterized by the DPOAE being normal, the shape of the pure tone loss being mostly in low frequencies, but the ABR being absent or the threshold elevated disproportionally to the pure tone threshold. Patients were screened from the deaf patients through asking the ill history and taking the exams of pure tone audiometry, auditory brain stem response, distortion product of otoaccoustic emissions (DPOAE). Thirty six patients were met the above standard. Deparaffined sections of cochlea of the guinea pigs were used as antigens to test whether the sera of patients had the autoantibodies with immunofluorescence method. RESULTS In the total of 36 patients with this type of hearing loss, autoantibodies were positive in 31 patients(86.1%). Twenty of the 31 patients had autoantibodiesto connective tissue of osseous spiral lamina where the nerve fiber connecting the hair cells and spiral ganglion cells go through. The autoantibodies to capsula surrounding the spiral ganglion and inner ear nerve fiber was also seen in these patients. In additional 7 patients, the autoantibodies to spiral ganglion cell nucleus and inner ear nerve fiber was detected. In the 44 control persons, 9.1% of them have the autoantibodies to inner ear tissues(P