Evidences of vascular origin of cochleovestibular dysfunction.

OBJECTIVES: When the vascular disorder of the cochleovestibular system is mentioned, the diagnosis is based on exclusion of other diseases. Since arteries of the cochleovestibular system cannot be directly visualized, physicians must deduce from the vascular risk factors and the vascular lesion of other territories to the vascular cochleovestibular disease. MATERIALS AND METHODS: Authors analyzed the data of 19 patients with vertigo. Detailed blood tests, complete neurootological and audiological examination including ABR, carotid and vertebral artery Doppler sonography, MRI and MRA was performed. RESULTS: Cochleovestibular examination and ABR showed abnormalities in 73.7%, either carotid and vertebral artery Doppler or MRI showed abnormalities in 57.9%. MRA was abnormal in 47.4%. In most of the patients multiple risk factors of cerebrovascular disorder could be found. CONCLUSIONS: The cochleovestibular system disorders can be considered to be of vascular origin if the examinations exclude other diseases, if the patients have vascular risk factors and if other territories of brain accessible for imaging methods show vascular disorders.

Can intravascular lymphomatosis mimic sinus thrombosis? A case report with 8 months' follow-up and fatal outcome.

We report a case of intravascular lymphomatosis of the brain with 8 months' follow-up and fatal outcome. Several MRI investigations revealed variegated, rapidly changing infarct-like lesions and invasion of the walls of the superior sagittal sinus and deep veins. When disturbances of the venous outflow are detected with multifocal infarct-like lesions, intravascular lymphomatosis should be considered in the differential diagnosis. Brain biopsy may ensure the proper diagnosis ante mortem, but failure of biopsy is frequent, as in our case.

First-trimester maternal gestational infection and cycloid psychosis.

Using a structured interview, the mothers of patients with cycloid psychosis, manic depression and controls (40 mothers in each case) were investigated in order to assess the occurrence of maternal gestational infection and other obstetric complications during pregnancy with the affected child. The cycloid psychoses with low heritability and a good long-term prognosis were found to be significantly associated with first-trimester respiratory infection (i.e. influenza and febrile cold). Furthermore, maternal infection seems to predict an early onset in cycloids. In manic depression, we failed to identify a significant link with maternal gestational infection or other obstetric complications. These findings are discussed in the light of our previous reports of an excess of maternal gestational infections during the second trimester in chronic schizophrenics. Our results suggest that the exogenously induced disturbances of fetal brain maturation during the first trimester of gestation caused by maternal respiratory infection via live virus or disturbed maternal immune response are involved in the aetiology of cycloid psychoses.