Vestibulary rehabilitation--election treatment method for compensating vestibular impairment.

OBJECTIVE: This paper aims to reveal the actual benefit of vestibular rehabilitation (VR) in patients with unilateral vestibular loss. PATIENT AND METHODS: Case report of a young female patient with acute unilateral vestibular loss due to facial nerve schwannoma developed above the internal auditory canal (IAC) from where it seems to have entered the IAC. Betahistine associated to VR treatment was recommended due to persisting imbalance after tumor removal. The benefit of the combined therapy was evaluated objectively (sensory organization test) and subjectively (questionnaires regarding self-perception of the deficit in quality of life). RESULTS: Both evaluations revealed great improvement in stability (SOT scores) as well as in health-related quality of life (HRQoL)--improvement of self-perception scores of disequilibrium in all questionnaires used. CONCLUSIONS: Combined recommended treatment (betahistine and VR) improves HRQoL after acute unilateral vestibular loss. It reduces self-perceived disability and intensity of symptoms during usual activities.

Giant wing sphenoid meningioma with principal manifestation depression.

UNLABELLED: A 68-year-old woman with no previous mental illness presented with a three-month history of decreased energy, fatigue, feelings of hopelessness, pessimism, difficulty concentrating, and persistent feelings of "emptiness", worthlessness, insomnia, appetite loss, diminished functionality. The patient's neurological examination was normal. She was diagnosis with major depressive disorder (MDD) by Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria and received psychiatric treatment. Resistance at therapy leaded at cerebral axial computed tomography (CT) indication. Cerebral CT-scan revealed an intracranial expansive mass (EPIC) located in frontal-temporal (F-T) right lobe, size 42/45/66 mm, hyperdense lesion, without peri-lesional edema, inserted on the great sphenoid wing, image suggestive for meningioma. MRI confirmed the presence of tumor and angiography showed the arterial source of the meningioma. The neurosurgical intervention removed successfully the tumor. Grossly examination revealed a giant tumor with a maximal diameter of 7 cm. The histological aspect of the tumor was highly representative for the diagnosis of meningioma. Patient mental status was evaluated at baseline, in preoperative period and postoperative period and had been using Hamilton Depression Rating Scale (HDRS) - 17 items version, Clinical Global Impression Scale (CGI), and Global Assessment of Functioning (GAF). After neurosurgical intervention, functioning was improving with completed remission of depression symptoms at six-month postoperative evaluation. CONCLUSION: Most meningiomas are slow growing and many are found incidentally. The decision to perform a cerebral CT-scan depends on the clinician's degree of suspicion that a tumor is present. A first depressive episode is a clinical condition with principal indication for cerebral CT-scan.