ABSTRACT
INTRODUCTION: Gentamicin has a well-known potential for damaging the peripheral vestibular organs. However, it is considered to be innocuous to the CNS as it crosses the blood-brain barrier poorly. Here, we describe central neuro-otological abnormalities developed by a patient after deployment of gentamicin into his spinal space. CASE SUMMARY: A 61-year-old male unintentionally received gentamicin during spinal locoregional anesthesia for a urological procedure. During the first 48 hours the patient presented upper extremity dysmetria, dysarthria, and bilateral abducens nerve paralysis from which he recovered completely. He remained asymptomatic from day 3 to 10 after the incident. On day 11 he presented an acute vestibular syndrome. Severe bilateral vestibulopathy was confirmed by means of video head impulse testing. From day 14 onwards, he presented a persistent horizontal left-beating nystagmus, showing no variation or signs of compensation after 14 months, not responding to intensive vestibular rehabilitation or vestibular suppressant drugs. During follow-up, intercurrent gaze-evoked/direction-changing nystagmus has been recorded in various opportunities. DISCUSSION: We interpreted these findings as signs of both severe peripheral bilateral vestibulopathy and cerebellar and/or midbrain late-onset neurotoxicity, which can be explained by the intrinsic neurotoxic capability of high doses of gentamicin in the CNS.
Subject(s)
Bilateral Vestibulopathy , Nystagmus, Pathologic , Vestibule, Labyrinth , Gentamicins/adverse effects , Humans , Male , Middle Aged , Nystagmus, Pathologic/chemically induced , Nystagmus, Pathologic/diagnosis , VertigoABSTRACT
Within the field of otolaryngology, the inner ear is perhaps the most important target for which stem cell and gene therapy may comprise elements of primary intervention strategies in the future. As it has done in the past, sensorineural hearing loss still represents a major therapeutic challenge-and it will continue to do so in the future. Current management strategies are not cause-orientated. Since the first experiments aimed at developing a middle ear-specific gene-based therapy by Fujiyoshi in 1994, several new discoveries have been made. In the laboratory, advances in the fields of genetics, molecular signalling, stem cell biology and hair cell development and regeneration have been made. Through these advances, the potential roll of cellular and intracellular tools for the future treatment of hearing loss has been recognized. This paper comprises a review of the current status of important areas of research.
