1/12. magnetic resonance imaging in patients with sudden hearing loss, tinnitus and vertigo.OBJECTIVE: The etiopathogenesis in audiovestibular symptoms can be elusive, despite extensive differential diagnosis. This article addresses the value of magnetic resonance imaging (MRI) in analysis of the complete audiovestibular pathway. STUDY DESIGN: Retrospective evaluation. SETTING: Tertiary referral center. patients: Consecutive sample of 354 patients (mean age 49 years, range 8 to 86 years) with audiovestibular disorders. INTERVENTION: Contrast-enhanced MRI of the head with thin-slice investigation of the inner ear, internal auditory meatus, and cerebellopontine angle. MAIN OUTCOME MEASURE: All MRIs were evaluated by experienced independent investigators. Statistical analysis was performed using the Statistical Package of social sciences data analysis 9.0. RESULTS: MRI abnormalities were seen in 122 of 354 patients (34.5%). The MRIs revealed the following: 4 pathologic conditions (1.1%) of the cochlea/labyrinth, 23 abnormalities (6.5%) at the internal auditory meatus/cerebellopontine angle, 12 pathologic lesions (3.4%) that involved the central audiovestibular tract at the brainstem, 78 microangiopathic changes of the brain (22%), 3 focal hyperintensities of the brain that turned out to be the first evidence of multiple sclerosis in 2 patients and sarcoidosis in 1 patient, and 1 temporal metastasis. Other pathologic conditions, such as parotid gland or petrous bone apex tumors, were unrelated to the audiovestibular symptoms. CONCLUSIONS: This study indicates that contrast-enhanced MRI can be used to assess a significant number of different pathologic conditions in patients with audiovestibular disorders.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
2/12. Cerebral cavernous malformations with dynamic and progressive course: correlation study with vascular endothelial growth factor.BACKGROUND: Cerebral cavernous malformations (CCMs) are reported to exhibit a wide range of dynamic patterns including growth, regression, and de novo formation, which generally show slow and steady courses. Although the pathogenesis of CCMs is not well known, vascular endothelial growth factor (VEGF) has been suggested as a possible mediating factor. OBJECTIVES: To report CCMs showing rapid progression over a short period and to investigate these biological characteristics. DESIGN: Experimental study. SETTING: Tertiary referral center, neurology department.Patient A 40-year-old man was admitted because of a left-sided numbness, vertigo, and ataxia, which were attributed to a pontine hemorrhage. He had experienced a left-sided weakness 6 months before admission, and thereafter had complained of intermittent headache. Serial brain magnetic resonance images showed multiple intracerebral microhemorrhages throughout the cerebral hemispheres. A biopsy of the lesion confirmed the diagnosis of CCM. MAIN OUTCOME MEASURES: We investigated the expression of VEGF by immunohistochemistry of the biopsy specimen. Dynamic patterns of CCMs, obtained with spin-echo magnetic resonance images with gradient-echo sequences, were compared with serial serum VEGF concentrations, determined by enzyme-linked immunosorbent assay. RESULTS: immunohistochemistry of the specimen displayed increased VEGF expression. Serial magnetic resonance images during 7 months showed dynamic signal changes of the preexisting lesions and 15 de novo formations in many cortices. The VEGF level in serum increased during this dynamic period and became normal during the steady and resolving stages. CONCLUSIONS: Cerebral cavernous malformations can be progressively deteriorating. The endothelial proliferation induced by VEGF is likely to be an important aspect of the pathogenetic mechanisms of CCMs.- - - - - - - - - - ranking = 0.25keywords = vertigo (Clic here for more details about this article) |
3/12. Hemorrhagic acoustic schwannoma: radiological and histopathological findings.A 49-year-old man on anticoagulation treatment with phenprocoumon presented with acute right sided 7th and 8th cranial nerve palsy, acute hearing loss, headache, vertigo, and vomiting. CT and MRI revealed a cerebellopontine angle tumor 15mm in diameter and acute intratumoral hematoma. A cellular schwannoma composed predominantly of Antoni A tissue with dilated thin-walled vessels, surrounded by old hemorrhage with hemosiderin-laden macrophages was found histologically.- - - - - - - - - - ranking = 0.25keywords = vertigo (Clic here for more details about this article) |
4/12. Multiple oligodendroglioma--case report.A 32-year-old male was hospitalized with headache and disturbance of consciousness. Computed tomography (CT) revealed a tumor and an intracranial hematoma in the right frontal lobe. The tumor was totally removed, and postoperative radiation therapy was administrated locally at 50 Gy. Five years later, he experienced sudden onset of headache and vertigo. CT demonstrated a mass lesion with a hematoma in the cerebellar vermis. The tumor was subtotally removed and he underwent postoperative local irradiation at 50 Gy as well as ventriculoperitoneal shunting. Four years later, he complained of visual and gait disturbances, and CT disclosed a tumor in the suprasellar region. Following partial removal of the tumor, local brain irradiation was given at 40 Gy. Histological examination proved all three tumors to be oligodendrogliomas with no evidence of malignant change.- - - - - - - - - - ranking = 0.25keywords = vertigo (Clic here for more details about this article) |
5/12. Acute vertiginous presentation of primary thalamic hemorrhage.A 43-year-old hypertensive patient presented with serve vertigo of abrupt onset. The initial neurological signs were subtle vertical gaze paralysis and unsteady gait. The computed tomographic scan revealed a left-sided thalamic hemorrhage. It is explained that the vertigo is due to stimulation of the vestibulo-ocular connections within the diencephalic-mesencephalic junction.- - - - - - - - - - ranking = 0.5keywords = vertigo (Clic here for more details about this article) |
6/12. Stereotactic evacuation of hypertensive cerebellar hemorrhage using plasminogen activator.Treatment for hypertensive cerebellar hemorrhage still remains controversial as to whether direct surgical procedure is indicated or not. This is so even after the introduction of CT scan which easily demonstrates the location and size of the hematoma and the presence of hydrocephalus. In this paper, we present our experience of 20 patients with cerebellar hemorrhage treated by stereotactic evacuation using Komai's CT-stereotactic apparatus. All the patients had vertigo, cerebellar symptoms, dysfunction of brain stem or consciousness disturbance. The hematomas on CT scan were more than 28 mm in diameter. Acute obstructive hydrocephalus occurred in 90% of the patients with hematoma 40 mm or larger in size. The patients with consciousness disturbance were immediately operated on after the attack, and a drainage tube was placed in the hematoma cavity to drain cerebrospinal fluid and liquefied hematoma for one to eight days. On the other hand, when patients with hematoma around 30 mm in diameter complained vertigo for about two weeks, they also were operated on stereotactically. After the operation, their symptoms improved rapidly. The stereotactic operation could aspirate about 85% of the estimated hematoma volume and improved the hydrocephalus, except in one case in which the patient rapidly deteriorated to coma level with a large cerebellar hemorrhage and brain stem damage. This stereotactic evacuation of cerebellar hematoma using a plasminogen activator is effective for not only the removal of hematoma, but also for the treatment of secondary hydrocephalus following obstruction of the fourth ventricle by cerebellar hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.5keywords = vertigo (Clic here for more details about this article) |
7/12. central nervous system cysticercosis simulating an acute cerebellar hemorrhage.We report the case of a Mexican man who suddenly developed severe occipital headache, vomiting, vertigo, and ataxia. neurologic examination showed nystagmus and cerebellar findings. Computed tomography of the brain demonstrated a large left cerebellar cystic lesion consistent with the diagnosis of cysticercosis. The patient was treated with dexamethasone and praziquantel and required surgical removal of the lesion to prevent herniation. He recovered without neurologic sequelae. The abrupt onset of cerebellar findings is an unusual presentation of this disease. central nervous system cysticercosis is being recognized with increasing frequency in the united states, where it is found primarily in Hispanic and Asian immigrants. The literature of central nervous system cysticercosis is reviewed and the pathogenesis, clinical presentation, and therapy are discussed.- - - - - - - - - - ranking = 0.25keywords = vertigo (Clic here for more details about this article) |
8/12. Cerebellar venous angiomas. A continuing controversy.We have studied three patients with angiographically documented cerebellar venous angioma (CVA). One patient had a subacute cerebellar hematoma and underwent posterior fossa craniotomy for evacuation of the hematoma and excision of the malformation. A hemorrhagic venous infarction of the brain stem and cerebellum occurred, and the patient died three weeks postoperatively. A second patient with an unruptured CVA had a history of headaches, tinnitus, and vertigo. Conservative treatment was elected, and the patient's condition remains unchanged after 11 months of follow-up. The third patient, recently diagnosed as having an unruptured CVA had episodic vertigo and disequilibrium. Conservative treatment was chosen, and he is asymptomatic after six months of follow-up. Based on a review of 24 other cases of CVA plus our experience we could not conclude any definite trend regarding natural history or treatment. However, conservative treatment seems the logical choice in patients with unruptured CVA.- - - - - - - - - - ranking = 0.5keywords = vertigo (Clic here for more details about this article) |
9/12. Positional vertigo and the cerebellar vermis.A patient with lower and posterior vermis hematoma presented with truncal ataxia; paroxysmal, positional, downbeating nystagmus; and saccade dysmetria. drainage of the hematoma resulted in complete resolution of all signs and symptoms.- - - - - - - - - - ranking = 1keywords = vertigo (Clic here for more details about this article) |
10/12. Primary medullary hemorrhage. Report of four cases and review of the literature.BACKGROUND: Primary medullary hemorrhage is uncommon. Its clinical profile and prognosis are not well known. We report four cases of medullary hemorrhage and a review of the English and French literature since 1964 to analyze the clinical presentation and prognosis. CASE DESCRIPTIONS: Of sixteen case reports of medullary hemorrhage reviewed from the literature, sixteen contained sufficient information for review and are included in this report. The age distribution of the patients was between 13 and 72 years, and 10 of these patients were men. The most frequent symptoms at onset were vertigo, sensory symptoms, and dysphagia. Presenting signs included palatal weakness, nystagmus, hypoglossal palsy, cerebellar ataxia, and limb weakness. The diagnosis was made at autopsy in 3 patients, at surgery in 3, by computed tomography in 4, and more recently by magnetic resonance imaging in 6. In nine instances the etiology of hemorrhage was undetermined; a ruptured vascular malformation was the cause in 3 patients, 1 was attributed to the use of anticoagulants, and hypertension was the suspected cause in the other 3 patients. mortality rate was 19%; however, survivors generally had nonincapacitating sequelaes. CONCLUSIONS: These findings indicate that primary medullary hemorrhage presents with a characteristic syndrome of sudden onset of headache and vertigo with neurological signs that correspond to various combinations of medial and lateral medullary involvement. In those patients who survive, prognosis usually is good.- - - - - - - - - - ranking = 0.5keywords = vertigo (Clic here for more details about this article) |
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