Doença de Creutzfeldt-Jakob: relato de caso / Creutzfeldt-Jakob disease: case report

As doenças priônicas fazem parte do grupo das síndromes de demência rapidamente progressiva com neurodegeneração. Em humanos, a doença de Creutzfeldt-Jakob é a mais prevalente. Atualmente, seu diagnóstico pode ser baseado em uma combinação do quadro clínico, ressonância magnética e eletroencefalograma com alterações típicas, juntamente da detecção de proteína 14- 3-3 no líquido cefalorraquidiano. Este relato descreve o caso de uma paciente de 74 anos, natural de Ubá (MG), admitida em um hospital da mesma cidade com quadro de demência de rápida progressão, com declínio cognitivo, ataxia cerebelar e mioclonias. No contexto clínico, aventou-se a possibilidade de doença de Creutzfeldt-Jakob e, então, foi iniciada investigação para tal, com base nos critérios diagnósticos. Também foram realizados exames para descartar a possibilidade de doenças com sintomas semelhantes. O caso foi diagnosticado como forma esporádica de doença de Creutzfeldt-Jakob. (AU)

Prion diseases are part of the rapidly progressive dementia syndromes with neurodegeneration. In humans, Creutzfeldt-Jakob disease is the most prevalent. Currently, its diagnosis may be based on a combination of clinical picture, magnetic resonance imaging, and electroencephalogram with typical changes, along with the detection of 14-3-3 protein in cerebrospinal fluid. This report describes the case of a 74-year-old woman from the city of Ubá, in the state of Minas Gerais, who was admitted to a hospital in the same city with a rapidly progressive dementia, cognitive decline, cerebellar ataxia and myoclonus. In the clinical context, the possibility of Creutzfeldt-Jakob disease was raised, and then investigation was started for this disease, based on the its diagnostic criteria. Tests have also been conducted to rule out the possibility of diseases with similar symptoms. The case was diagnosed as a sporadic form of Creutzfeldt-Jakob disease. (AU)

Evaluación inicial del paciente con mareos y vértigo / Initial evaluation of the patient with dizziness and vertigo

El paciente que consulta por mareos o vértigo es sin duda un desafío para el médico que trabaja en un servicio de urgencia. Esto se da en parte por la dificultad de los pacientes de definir el síntoma, a la amplia gama de diagnósticos diferenciales y su potencial riesgo de desenlace negativo, como en el caso del accidente cerebrovascular de fosa posterior. En esta revisión narrativa, el objetivo: es explicar el enfrentamiento inicial del paciente con mareos y vértigo, describir las pruebas y métodos diagnósticos complementarios, distinguir los diagnósticos diferenciales más frecuentes y explicar el manejo inicial. Método:se realizó una revisión bibliográfica de literatura científica sobre esta patología, basado en la propuesta de Edlow (2016), donde se enfatiza en un enfoque basado en temporalidad, factores desencadenantes y contexto del síntoma.(AU)

The patient who consults for dizziness or vertigo is undoubtedly a challenge for the emergency physician. This is partly due to the difficulty of the patients to define the symptom, the wide range of differential diagnoses and their potential risk of negative outcome, as in the case of posterior circulation stroke. In this narrative review, the objective is to explain the initial approach of the patient with dizziness and vertigo, describe the tests and complementary diagnostic methods, distinguish the most frequent differential diagnoses and explain the initial management. A bibliographic review of the scientific literature on this pathology was carried out, based on the proposal of Edlow (2016), which emphasizes an approach based on temporality, trigger factors and context of the symptom. (AU)

Vestibular Histopathology in Temporal Bone / 대한평형의학회지

There are a number of reports on the pathologies of vestibular disorders. However, these studies included only a few examples, which were not quantitative but merely anecdotal or descriptive. However, a single tissue section may be relevant to a specific disease in multiple ways. The histopathological characteristics of common peripheral vestibulopathies, including benign paroxysmal positional vertigo, Ménière's syndrome, labyrinthitis, vestibular neuritis, and ototoxicity, have been described. A recent study validated a new quantitative method for determining vestibular otopathology. Detailed quantitative analyses of vestibular pathology are required to obtain a deeper understanding of the vestibular system. Such studies will likely reveal the pathophysiological causes of specific diseases by elucidating the correlations between structural and functional features. Therefore, histopathological studies of vestibular disorders should be performed.

Computed Tomography and Magnetic Resonance Imaging Evaluation in Pediatric Unilateral Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Children with unilateral sensorineural hearing loss (USNHL) are not actively evaluated by physicians. The diagnostic tool for evaluation of USNHL is also controversial, and no strategy for diagnosing USNHL through imaging studies has been established. We examined the results of temporal bone computed tomography (TBCT) imaging and magnetic resonance imaging (MRI) studies on children with USNHL. SUBJECTS AND METHOD: Eighty-nine patients with USNHL were reviewed. Of these patients, 21 underwent both TBCT and MRI, 51 underwent temporal MRI only, and 17 underwent TBCT only. RESULTS: The etiology of USNHL were determined through imaging studies in 20 patients. The most common abnormal finding (65%) was a narrow internal auditory canal identified on TBCT and cochlear nerve aplasia on temporal MRI. Incomplete partition (20%), common cavity (10%), and labyrinthitis ossificans (5%) were also observed in imaging studies. The hearing threshold was lower in USNHL patients with normal findings (76.1±28.7 dB) than in USNHL patients with abnormal findings on TBCT or temporal MRI (100.1±22.3 dB). CONCLUSION: Cochlear and cochlear nerve abnormalities can be detected through imaging studies in approximately 25% of patients with USNHL. Therefore, we suggest that children should undergo TBCT when USNHL is confirmed through audiologic evaluation.

Kawasaki Disease and Labyrinthitis: An Underdiagnosed Complication

Sensorineural hearing loss (SNHL) that is seldom cited as a Kawasaki disease (KD) complication is known as an additional, potentially severe, and frequently irreversible sequel. Furthermore the vestibular functions of KD have been underestimated and it could be an important complication combined with SNHL in KD. We described a case that a 4 year-old boy who developed vestibular loss with SNHL has recovered successfully with a combined treatment.

A Case of Scala Vestibuli Cochlear Implantation in Tympanogenic Labyrinthitis Ossificans / 대한이비인후과학회지

Labyrinthitis ossificans (LO) is a pathologic formation of fibrosis and new bone within the lumen of the otic capsule. The LO is a challenging issue in cochlear implantation since obliteration and obstruction of the cochlea make electrode insertion through scala tympani (classic route) difficult. Moreover, tympanomastoidectomy for resolution of chronic otitis media is also simultaneously considered for tympanogenic LO with severe to profound hearing loss because ossification could progress in case of staged or delayed implantation after initial tympanomastoidectomy. We report a patient with tympanogenic LO, who received subtotal petrosectomy with simultaneous cochlear implantation via scala vestibuli instead of the scala tympani for hearing rehabilitation.

A Case of Labyrinthitis Ossificans Presenting as an Intractable Benign Paroxysmal Positional Vertigo / 대한평형의학회지

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. It is easily cured with canal repositioning maneuvers, but some patients are resistant to the repositioning maneuver and require surgical intervention. Labyrinthitis ossificans is the pathologic condition that fibrous tissue and new bone occupy the membranous labyrinthine space. It occurs as a sequela of inner ear inflammation resulting from diverse causes, mostly bacterial meningitis and otitis media. We describe here a 42-year-old female patient with refractory posterior semicircular canal (PSCC) BPPV and adhesive otitis media in same ear. Otoscopic examination revealed adhesive tympanic membrane without middle ear space and temporal bone computed tomography showed complete ossification of the labyrinth at the same side. We performed a canal wall down mastoidectomy and PSCC occlusion. The patient had complete resolution of paroxysmal vertigo and positional nystagmus, postoperatively.

Bacterial Meningitis Initially Presenting as Labyrinthitis / 대한평형의학회지

Labyrinthitis causes damage to inner ear structure, and in turn hearing loss and vertigo. Labyrinthitis is classified as otogenic labyrinthitis and meningogenic labyrinthitis. Otogenic labyrinthitis can be diagnosed early through otoscopic examination. However, when there are no characteristic neurologic symptoms in patients with meningogenic labyrinthitis, clinicians can overlook the underlying meningitis and this may lead to the peripheral vertigo. We encountered an unusual case of meningogenic labyrinthitis that is misdiagnosed as peripheral dizziness.

Suppurative labyrinthitis associated with otitis media: 26 years' experience / Labirintite associada à otite média: experiência de 26 anos

ABSTRACT INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57%) of whom were females and six (43%) males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%), acute suppurative otitis media in six (43%), and chronic otitis media without cholesteatoma was diagnosed in two patients (14%). Besides labyrinthitis, 24 concomitant complications were identified: six cases (25%) of labyrinthine fistula, five cases (21%) of meningitis, five cases (21%) of facial paralysis, five cases (21%) of mastoiditis, two cases (8%) of cerebellar abscess, and one case (4%) of temporal abscess. There was one death. Eight (57%) individuals became deaf, while six (43%) acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

RESUMO INTRODUÇÃO: Labirintite permanece resultando em deficiência auditiva significativa, apesar dos esforços científicos para melhorar não só o diagnóstico, como também o tratamento. O diagnóstico definitivo é dependente de imagens da orelha interna, mas geralmente é presumido clinicamente. OBJETIVO: Analisar os fatores clínicos e os resultados auditivos em pacientes com labirintite secundária à otite média e discutir os achados dos exames de imagem. MÉTODO: Estudo de coorte retrospectivo, com base nos prontuários de pacientes diagnosticados com labirintite associada à infecção da orelha média. RESULTADOS: Foram identificados 14 pacientes, oito (57%) do sexo feminino e seis (43%) masculino. Média etária de 40 anos. Otite média crônica colesteatomatosa foi diagnosticada em seis pacientes (43%), otite média aguda em seis pacientes (43%) e otite média crônica sem colesteatoma em dois pacientes (14%). Foram identificadas 24 complicações concomitantes: seis casos (25%) de fístula labiríntica, cinco casos (21%) de meningite, cinco (21%) de paralisia facial, cinco (21%) de mastoidite, dois casos (8%) de abscesso cerebelar e um caso (4%) de abcesso temporal. Houve uma morte. Oito (57%) indivíduos tornaram-se anacústicos, enquanto seis (43%) evoluíram para perda auditiva mista. CONCLUSÃO: Labirintite foi frequentemente associada a outras complicações; RNM auxiliou no diagnóstico definitivo da labirintite na sua fase aguda; a sequela auditiva da labirintite foi significativa.

A Case of Bacterial Meningoencephalitis Following Sudden Sensorineural Hearing Loss with Vertigo / 대한이비인후과학회지

We report a case of sudden sensorineural hearing loss with vertigo in a 68-year-old woman, who developed bacterial meningoencephalitis during steroid treatment. The patient initially showed severe degree of sensorineural hearing loss on the left side with spontaneous nystagmus beating toward the contralateral side. Brain magnetic resonance imaging demonstrated no abnormal finding other than high signal intensity in parts of mastoid air cells and mild mucosal hypertrophy of the paranasal sinuses. During the course of steroid treatment, the hearing worsened to profound hearing loss, and on the 6th day of steroid treatment, the patient demonstrated dysarthria and disorientation with subsequent development of high fever. The patient was diagnosed with bacterial meningoencephalitis and treated with antibiotics. The patient recovered without any neurologic deficit but unilateral profound hearing loss persisted. The case is presented here along with a possible pathogenic mechanism of bacterial meningoencephalitis following sudden sensorineural hearing loss in this patient.

Benign Paroxysmal Positional Vertigo with Simultaneous Involvement of Multiple Semicircular Canals

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) generally involves a single semicircular canal (single canal BPPV) but it has been reported that more than one semicircular canal on either the same or the opposite side can be involved in 6.8-20% of the cases (multiple canal BPPV). In this study, the clinical characteristics of multiple canal BPPV were analyzed and compared to those of single canal BPPV. MATERIALS AND METHODS: Retrospective analysis was performed on 1054 consecutive patients diagnosed with BPPV. Multiple canal BPPV was diagnosed when the combination of typical nystagmus was provoked by the Dix-Hallpike and supine head roll tests. Canalith repositioning maneuver was performed sequentially starting with the semicircular canal causing more severe nystagmus or symptoms. Clinical characteristics and the treatment course were statistically compared between single canal BPPV and multiple canal BPPV. RESULTS: Among the 1054 patients, single canal BPPV was diagnosed in 1005 patients (95.4%) while multiple canal BPPV was diagnosed in 49 patients (4.6%). BPPV involving semicircular canals on the same side was more common (79.6%) than BPPV with bilateral involvement. The most common combination of the involved canals was ipsilateral posterior and horizontal semicircular canals (63.3%). Multiple canal BPPV was significantly more associated with underlying otologic diseases, especially labyrinthitis. Multiple canal BPPV required more treatment sessions and longer duration of treatment to achieve resolution of nystagmus and symptoms. CONCLUSIONS: As all cases of multiple canal BPPV were treated successfully although a longer duration of treatment and more treatment sessions were required compared to single canal BPPV, the results of our study could aid in making an accurate diagnosis and providing appropriate treatment of multiple canal BPPV.

A Case of Labyrinthine Fistula by Cholesteatoma Mimicking Lateral Canal Benign Paroxysmal Positional Vertigo

Acute peripheral vestibulopathy, of which the chief complaint is positional vertigo, comprises benign paroxysmal positional vertigo (BPPV), labyrinthitis, labyrinthine fistula, and cerebellopontine angle tumors. Since the typical presentation of labyrinthine fistulas may be sensorineural hearing loss, positional vertigo, or disequilibrium, it is often difficult to distinguish from BPPV or Meniere's disease. Herein we report a 61-year-old female patient with typical symptoms and signs attributable to geotropic type variant of the lateral semicircular canal BPPV on the left side, who eventually was confirmed as having a labyrinthine fistula from chronic otitis media with cholesteatoma on the left side. This is another case where, even in the presence of isolated vertigo showing typical findings of acute peripheral vestibulopathy, other otologic symptoms and signs must not be overlooked.

Clinical aspects and dynamics of auricular parasitosis in Gir cattle / Aspectos clínicos e dinâmica de parasitoses auriculares em bovinos da raça Gir

We evaluated the dynamics of ear infestations caused by Rhabditis spp. and Raillietia spp., which were correlated with animal age, intensity of clinical signs and climate factors. Sixty-four Gir cattle were distributed into three groups: GA - 23 calves with 4 to 6 months of age; GB - 18 calves with 7 to 12 months of age; and GC - 23 heifers with 13 to 33 months of age. Five samplings, defined as S1, S2, S3, S4 and S5 were performed every three months from August 2008 to August 2009. The ear secretion was collected using the auricular washing method for the right ear and a swab for the left ear. A clinical assessment of the animals was performed, and they were classified according to the presence and severity of otitis. The highest relative frequency of rhabditosis was 52.2% in GC at the last sampling. In the first sampling, 42.2% of the animals were infested by Raillietia spp. The older cattle were more susceptible to infestations by both parasites. No correlation of Rhabditis spp. and Raillietia spp. parasitism with climate factors was found. The results showed that both parasites could infest Gir cattle, and in most cases, there was no co-infestation. Only older animals parasitized by the nematode showed clinical signs of the disease.

Avaliou-se a dinâmica da infestação auricular causada por Rhabditis spp. e por Raillietia spp., relacionando-a com a idade dos animais, com a intensidade dos sinais clínicos e com os fatores climáticos. Utilizaram-se 64 bovinos Gir, distribuídos em três grupos: GA - 23 bezerros de quatro a seis meses de idade, GB - 18 bezerros de sete a 12 meses e GC - 23 novilhas de 13 a 33 meses. Foram feitas cinco coletas a cada três meses. A secreção auricular foi coletada utilizando o método de lavagem auricular na orelha direita e um swab na orelha esquerda. Fez-se avaliação clínica dos animais classificando-os de acordo com a presença e gravidade da otite. A maior frequência relativa da rhabditiose encontrada foi de 52,2%, no GC na ultima coleta. Na primeira coleta, 42,2% dos animais estavam infestados pela Raillietia spp. Os bovinos mais velhos foram mais suscetíveis às infestações de ambos os parasitos. Não foi encontrada correlação entre o parasitismo por Rhabditis spp. e por Raillietia spp. e os fatores climáticos. Concluiu-se que ambos os parasitas podem infestar bovinos da raça Gir e na maioria dos casos, não ocorreram infestações simultâneas. Apenas os animais mais velhos, parasitados pelo nematóide, apresentaram sinais clínicos da doença.

Tuberculous Otitis Media with Facial Paralysis Combined with Labyrinthitis

Tuberculosis otitis media is a very rare cause of otorrhea, so that it is infrequently considered in differential diagnosis because clinical symptoms are nonspecific, and standard microbiological and histological tests for tuberculosis often give false-negative results. We present a rare case presenting as a rapidly progressive facial paralysis with severe dizziness and hearing loss on the ipsilateral side that was managed with facial nerve decompression and anti-tuberculosis therapy. The objective of this article is to create an awareness of ear tuberculosis, and to consider tuberculosis in the differential diagnosis of chronic otitis media with complications.

Risk Factors for Treatment Failure in Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Particular repositioning maneuver (PRM) have been recommended as a treatment of benign paroxysmal positional vertigo (BPPV). Some patients require multiple treatments for remission, although most of the patients are treated at the first trial of single maneuver. The purpose of this study was to evaluate risk factors for the treatment failure in patients with posterior canal BPPV (p-BPPV) and horizontal canal BPPV (h-BPPV). SUBJECTS AND METHOD: Retrospective review was performed for the 287 patients diagnosed as BPPV visiting the dizziness clinic between February 2011 and August 2012. The diagnostic criteria for BPPV were met by following the guidelines provided by the American Academy of Otolaryngology-Head and Neck Surgery. Patients were classified into two groups: Group 1 (treatment success) that requires only 1 PRM and Group 2 (treatment failure) that requires more than 2 PRMs. We analyzed the relationship between treatment failure and the clinical characteristics, and studied the etiology of BPPV. RESULTS: The study included 183 patients with p-BPPV, 54 patients with h-BPPV (geotropic type), and 50 patients with h-BPPV (apogeotropic type). The type of BPPV and average numbers of PRM required for remission were significantly related with treatment failure by statistical analysis (p<0.05, respectively). Statistically significant correlation was demonstrated between the history of ipsilateral inner ear viral infection (acute vestibular neuritis, sudden sensorineural hearing loss) and treatment failure (p<0.05). CONCLUSION: Multiple PRMs may be required in patients with h-BPPV (apogeotropic type) or with secondary BPPV caused by ipsilateral inner ear viral disease. Clinically, this information may be used to provide helpful information for clinicians performing PRM to treat BPPV.

Trombose de artéria basilar: relato de caso / Basilar artery thrombosis: case report

JUSTIFICATIVA E OBJETIVOS: O acidente vascular encefálico vértebro-basilar é uma entidade difícil de ser reconhecida através de dados semiológicos, pois pode se apresentar clinicamente semelhante a uma labirintopatia. O objetivo deste estudo foi alertar sobre os sintomas apresentados pelo paciente com vertigem central para se fazer um diagnóstico precoce. A justificativa baseia-se no quadro de um paciente com vertigem e vômitos, avaliado como uma labirintopatia, chamando atenção de dados semiológicos úteis na distinção entre a vertigem central e a periférica. RELATO DO CASO: Paciente do sexo masculino, 69 anos, hipertenso foi atendido em pronto-atendimento com vertigem, vômitos e mal estar. Medicado com metoclopramida, dimenidrinato, clonazepam. Alta com melhora parcial do quadro, suspeitando labirintite. Orientado consulta com otorrinolaringologia. No dia seguinte evoluiu com incapacidade de marcha, vertigem, vômitos, rebaixamento do nível de consciência e descerebração bilateral. Submetido à intubação orotraqueal. Tomografia computadorizada de crânio (TCC) revelou sinal de hiperdensidade da artéria basilar sugerindo trombose,confirmada pela angiografia. Tendo-se em vista quadro neurológico e tempo de evolução impreciso, optou-se por não utilizar trombolítico. No dia seguinte, o paciente apresentava-se em coma (Glasgow = 3),TCC revelando acidente vascular encefálico isquêmico (AVEI) agudo vértebro-basilar extenso evoluindo para óbito 72 horas após. CONCLUSÃO: A distinção entre vertigem central ou periférica é um desafio semiológico. O diagnóstico precoce do AVEI por TCC é limitado. O conhecimento de dados semiológicos é uma ferramenta indispensável para o reconhecimento do AVE vértebro-basilar em unidades de PA.

BACKGROUND AND OBJECTIVES: Vertebrobasilar strokeis a difficult entity to be recognized through semiological data, because it can be clinically similar to a labyrinthopathy. This study aims at alerting about the symptoms of patients with central vertigo to make an early diagnosis, as the clinical picture of vertigo and vomiting can be diagnosed as a labyrinthopathy; it also aims at drawing attention to semiological data useful for distinguishing between the peripheral and central vertigo. CASE REPORT: Male patient, 69 years, hypertensive, was seen in an emergency service with dizziness, vomiting, malaise. He was given metoclopramide, dimenhydrinate, and clonazepam. He was discharged with partial improvement of his condition and suspicion of labyrinthitis. He was referred to an otorhinolaryngologist. The next day he progressed with inability to walk, dizziness, vomiting, decreased level of consciousness and bilateral decerebration. He underwent orotracheal intubation. Computed tomography (CT) revealed hyperdensity sign of basilar artery suggestive of thrombosis, confirmed by angiography. Due to the neurological symptoms and inaccurate time course, we chose not to use thrombolytic therapy. The next day, the patient was in coma (Glasgow= 3), with CT revealing extensive acute vertebrobasilar ischemic stroke (AIS) that progressed to death in 72 hours. CONCLUSION: The distinction between central or peripheral vertigo is a semiological challenge. Early diagnosis of AIS by brain TC is limited. The knowledge of semiological data is an indispensable tool for the recognition of vertebrobasilar stroke in emergency care.

Cervical Vestibular Evoked Myogenic Potential and Ocular Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuritis and Acute Viral Labyrinthitis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Vestibular neuritis predominantly affects the superior branch of the vestibular nerve, resulting in vertigo. Acute viral labyrinthitis occurs when an infection affects both vestibulo-cochlear nerve and labyrinth, resulting in hearing changes as well as vertigo. The purpose of study is to identify there is a difference of cervical vestibular evoked myogenic potentials (cVEMP) and ocular VEMP (oVEMP) in patients with vestibular neuritis and acute viral labyrinthitis. MATERIALS AND METHODS: cVEMP and oVEMP tests using 500-Hz tone-burst stimuli were performed on patients with vestibular neuritis and acute viral labyrinthitis. Pure tone audiometry, caloric test and subjective visual vertical (SVV) were performed in all patients. We compared the VEMP results, SVV, caloric test in patients with vestibular neuritis and acute viral labyrinthitis. RESULTS: Abnormal cVEMP responses were detected in 2 (20%) patients with vestibular neuritis and 5 (100%) patients with labyrinthitis. Abnormal oVEMP responses were detected in 9 patients (90%) with vestibular neuritis and 5 (100%) patients with labyrinthitis. oVEMP abnormalities is correlated with caloric test and subjective visual vertical in patients with vestibular neuritis and labyrinthits. CONCLUSION: Our results shows that the response of cVEMP and oVEMP between patients with vestibular neuritis and acute viral labyrinthitis is different. We can infer that oVEMP response to air-conducted sound is different vestibular origin compared to cVEMP and may originate from utricle.

Isolated Flocculus Infarction Mimicking Acute Labyrinthitis

Acute vestibular syndrome characterized by vertigo, spontaneous nystagmus, and postural instability is caused by a unilateral injury to either peripheral or central vestibular structures. However, central vestibular syndromes, such as labyrinthine ischemia due to occlusion of anterior inferior cerebellar artery (AICA), may cause abrupt unilateral labyrinthine dysfunction that mimics peripheral vestibulopathy. Here we report an AICA infarction with isolated flocculus lesion on magnetic resonance imaging mimicking acute labyrinthitis with vertigo, unidirectional horizontal-torsional nystagmus, ipsilesional sensorineural hearing impairment, and positive head-thrust test without any typical findings of floccular lesion.

Sudden Sensorineural Hearing Loss Occurring after Blunt Head Trauma

Sudden sensorineural hearing loss (SNHL) due to blunt head trauma is a rare condition. Possible causes of SNHL by head trauma include cellular injury, perilymphatic fistula, labyrinthine concussion due to microfracture in inner ear and blunt trauma with simultaneous acute labyrithitis. We report here on two unusual cases in which cochleovestibular functions were totally damaged in patients with sudden SNHL due to blunt head trauma. Both cases presented with vertigo, tinnitus and a sudden onset of hearing impairment in the unilateral ear after blunt trauma. Audiograms revealed a profound to severe unilateral SNHL. Caloric testing revealed a decreased caloric response of 100% in the ipsilateral side compared to the contralateral side. Vestibular evoked myogenic potential testing revealed no response in the ipsilateral ear. Neither patient recovered hearing despite oral and/or intratympanic steroid therapy.