Audio-vestibular and radiological analysis in Meniere's disease

Abstract Objective: Intravenous gadolinium-enhanced inner ear magnetic resonance imaging (IV Gd-enhanced inner ear MRI) is a new technique for diagnosing Meniere's disease (MD). Vestibular tests have also long been used forMD, but which tests should be included in the oto-neurological test battery remains controversial. The evaluation method to be used to confirm the clinical diagnosis in MD is not clear. This study aimed to examine the results of vestibular tests and IV Gd-enhanced inner ear MRI in individuals diagnosed with unilateral definite Meniere's disease. Methods: IV Gd-enhanced inner ear MRI (Endolymphatic Hydrops [EH] and Perilymphatic Enhancement [PE]), conventional audiometry (0.25-8kHz), video Head Impulse Test (vHIT), cervical Vestibular Evoked Myogenic Potential (cVEMP), air caloric test, and dizziness handicap inventory were applied to 16 adult patients diagnosed with unilateral definite MD. Results: Among the patients with definite MD, EH (cochlear and/or vestibular) was identified in 93.7% and 68.7% of the symptomatic and the asymptomatic ears, respectively. There was a positive correlation between the hearing thresholds at 2, 4, 6 and 8 kHz and the degree of cochlear EH (p < 0.05). PE (cochlear and/or vestibular) was observed in 37.5% of the asymptomatic and symptomatic ears. The sensitivity of the vestibular test battery (vHIT, cVEMP, and caloric test) was 100% and its specificity was 50%, while the sensitivity of the IV Gd-enhanced inner ear MRI (EH and PE together) was 93.8% and the specificity was 81.3%. Conclusion: MRI had higher sensitivity and specificity than the vestibular test battery. PE or vHIT alone was not considered to be reliable in the diagnosis of MD. In suspected MD, the clinical history, hearing tests, and IV Gd-enhanced inner ear MRI are sufficient for diagnosis. If MRI technique is not possible, vestibular tests (caloric test and cVEMP, not vHIT) can provide reliable results when evaluated together.

Abdominal Aortic Hypoplasia, a Rare Cause of Hypertension.

Hypoplasia of the abdominal aorta is an exceedingly rare vascular abnormality. Congenital, acquired, infectious and inflammatory etiologies have been described. Hypertension is the most common presenting symptom. Besides hypertension, lower extremity claudication and mesenteric ischemia can be seen. Symptoms typically occur within the first three decades of life. Hypoplasia of the abdomanial aorta is considered a life threatening condition as a result of complications associated with severe hypertension. In this article we present a hypertensive patients with hypertrophic left heart, dilation of the ascending aorta and the aortic root, hypoplastic stenosis of the abdominal aorta, celiac trunc, and the places of origin of superior mesenteric and renal arteries and arch of Riolan (collaterals between the mesenteric arteries). Abdominal aortic hypoplasia is presented as a rare cause of hypertension.