1/14. Radionuclide cisternography in spontaneous intracranial hypotension with simultaneous leaks at the cervicothoracic and lumbar levels.This case report clearly illustrates defined simultaneous cerebrospinal fluid leaks at the cervicothoracic and upper lumbar areas. A 53-year-old woman without a remarkable medical history was hospitalized for sudden onset of severe headache. The headache lasted more than 1 week and standing or sitting positions exaggerated the symptoms, although it was relieved when the patient was recumbent. Radionuclide cisternography was performed using 150 MBq (4 mCi) Tc-99m DTPA. It revealed two cerebrospinal fluid leaks from the cervicothoracic junction bilaterally and the left side of the upper lumbar area. Epidural blood patching was tried at the lumbar level (L1-L2) and showed only a transient effect. A second trial of this method at the level of C7-T1 performed 2 days later resulted in immediate improvement of the symptoms without recurrence. The simultaneous cerebrospinal fluid leaks were detected successfully with radionuclide cisternography using Tc-99m DTPA, which provided a useful guideline for treatment despite the limitations of delayed scanning.- - - - - - - - - - ranking = 1keywords = intracranial hypotension, hypotension (Clic here for more details about this article) |
2/14. Objective tinnitus in children.OBJECTIVE: To discuss the various symptoms and causes of objective tinnitus in children. STUDY DESIGN: Retrospective case review. patients: Five children who had audible signals emanating from their ears caused by audible spontaneous otoacoustic emissions, palatal myoclonus, arteriovenous malformation, and acoustic trauma. MAIN OUTCOME MEASURE: The tinnitus reported by the patients was linked to acoustic signals that could be measured objectively or heard by the examiner. RESULTS: Four of the five children had essentially normal hearing. The one child who demonstrated a hearing loss audiometrically was thought to have normal hearing sensitivity, but his intense roaring objective tinnitus appeared to mask his low-frequency thresholds. All five patients had measurable acoustic signals in the ear canal that matched the patients' descriptions of their tinnitus. CONCLUSION: The cases illustrate how the objective tinnitus was diagnosed and measured, how a treatment algorithm was applied, and the expected results of treatment. In addition, the cases provide support for the use of psychologic counseling throughout the examination and treatment of objective tinnitus in children.- - - - - - - - - - ranking = 1.4847123507065E-5keywords = essential (Clic here for more details about this article) |
3/14. Objective tinnitus associated with essential laryngeal myoclonus: report of two cases.We report on two patients with an objective tinnitus. In the first one, the objective tinnitus was unique as it was due to bilateral rhythmic contractions of the vocal cords. In the second, the objective tinnitus arose from eustachian tube contractions and was associated with up and down movements of the larynx. In both patients, the abnormal laryngeal movement shared most of the characteristics of palatal or palatolaryngeal myoclonus and was thought to be laryngeal myoclonus. Its origin remained essential as all the investigations were negative.- - - - - - - - - - ranking = 7.4235617535325E-5keywords = essential (Clic here for more details about this article) |
4/14. Orthostatic tinnitus: an otological presentation of spontaneous intracranial hypotension.Spontaneous intracranial hypotension (SIH) is a syndrome characterized by orthostatic headache, low cerebrospinal fluid (CSF) pressure without apparent causes for CSF loss, and diffuse pachymeningeal gadolinium enhancement on cranial MRI. Hearing is affected in some patients with SIH. A case of SIH with orthostatic tinnitus is reported. A 51-year-old woman developed a severe headache that was almost completely relieved on recumbency. Cranial MRI with gadolinium infusion showed diffuse enhancement of the dura mater. Radionuclide cisternography demonstrated CSF leaks at the upper and lower thoracic levels. Epidural blood patches at these leak sites alleviated the orthostatic headache, however, orthostatic tinnitus and muffled hearing persisted. Initial audiometry was unremarkable; repeat audiometry performed 6 weeks later demonstrated low-frequency hearing loss in the right ear. Continuous epidural saline infusion for 3 consecutive days was performed; auditory symptoms disappeared 4 weeks thereafter. This case illustrates that orthostatic tinnitus represent intracranial hypotension even in the absence of orthostatic headache. MRI with gadolinium infusion should be carried out in the evaluation of patients with orthostatic tinnitus.- - - - - - - - - - ranking = 1.5keywords = intracranial hypotension, hypotension (Clic here for more details about this article) |
5/14. intracranial hypotension: aggravation of headache at high altitude.Spontaneous intracranial hypotension is an increasingly recognized disorder, often, although not always, characterized by the triad of low-opening cerebrospinal fluid pressure on lumbar puncture, postural headache, and diffuse parenchymal meningeal enhancement on magnetic resonance imaging of the head. We describe an unusual case of a patient with spontaneous intracranial hypotension presenting with postural headache and tinnitus, aggravated at high altitudes.- - - - - - - - - - ranking = 0.50455704938158keywords = intracranial hypotension, hypotension (Clic here for more details about this article) |
6/14. Pulsatile tinnitus: treatment with clonazepam and propranolol.Pulsatile tinnitus synchronous with heartbeat is rare and normally has vascular origin: arterial (malformation, arterial anatomical variation) or venous (aberrant jugular bulb, glomus tumors, tympanic glomus tumor). Early etiology identification is essential for appropriate treatment to be established. Magnetic angioresonance makes the vascular identification possible and precise. We report a case of arterial anatomical variation in which the treatment was propranolol and clonazepam, showing tinnitus improvement.- - - - - - - - - - ranking = 1.4847123507065E-5keywords = essential (Clic here for more details about this article) |
7/14. Treatment of essential palatal myoclonus in a 10-year-old girl with botulinum neurotoxin.Palatal myoclonus (PM) is a rare neurotological disorder but is being reported with increasing frequency. Two forms, symptomatic and essential PM, have been identified as separate clinical entities and probably also have separate etiologies. In essential PM, brain imaging is unremarkable and a clicking noise caused by peritubal muscle contractions and often audible by the examiner usually is the patients' chief complaint. The treatment of essential PM with systemic application of anticonvulsants and related substances as well as by destructive surgical means has yielded unsatisfactory results. Recently, the use of botulinum neurotoxin has emerged as a new treatment option that seems particularly attractive due to its safety, complete reversibility, very few side effects, and minimal invasiveness. We report the case of essential PM in a 10-year-old girl who was successfully treated with botulinum toxin injections under eletromyographic guidance and we review the literature on the use of botulinum toxin in PM.- - - - - - - - - - ranking = 0.00011877698805652keywords = essential (Clic here for more details about this article) |
8/14. Periodic saccadic oscillations and tinnitus.A man with essential hypertension developed stereotyped cycles of oscillopsia and bilateral "sparking" tinnitus. eye movement recordings showed cycles of disconjugate opsoclonus, square-wave jerks, and saccadic dynamic overshoot disrupting stable fixation. neuroimaging studies were normal. We postulate a lesion episodically disturbing saccade-related neurons and central auditory neurons in the pons.- - - - - - - - - - ranking = 1.4847123507065E-5keywords = essential (Clic here for more details about this article) |
9/14. Acoustic tumors in the young adult.Despite the widely held notion that acoustic neuroma is a disease of the middle and late years of life, this neoplasm frequently begins in young adults. It has been reported as occurring in a patient as young as seven years of age. Often, patients in their 20s or 30s may have minimal symptoms despite sizable tumors. Constant alertness for such lesions is essential for early diagnosis and optimal prognosis.- - - - - - - - - - ranking = 1.4847123507065E-5keywords = essential (Clic here for more details about this article) |
10/14. Contralateral suppression of transiently evoked otoacoustic emissions and tinnitus.The present paper reports individual data obtained in three different patients who consulted for unilateral tinnitus in the Department of otolaryngology. After pure tone and high-frequency audiometry, Audioscan audiometry was recorded, and tinnitus measurement which comprised a determination of pitch and loudness matches. Spontaneous, transient evoked and 2f1-f2 distortion product otoacoustic emissions at 65 dB SPL stimulus intensity were then determined. The functioning of the medial olivocochlear system (MOC) was also tested from a comparison between OAE input/output curves obtained in the presence and absence of 30 dB SL contralateral stimulation by a broadband noise: MOC global effectiveness was assessed through transient evoked emissions while those concerning distortion product emissions allowed a precise testing at the tinnitus frequency itself. The examples here displayed illustrate the diversity of results that can be found in such investigations, thereby preventing a general law to be established from the global testing of MOC functioning. On the contrary, the local testing at the precise frequency of tinnitus revealed the existence of an alteration of MOC functioning in at least one ear as shown by either a weak, null or inverse effect of contralateral stimulation. A better understanding of the sensorineural forms of tinnitus should come from the extensive investigation of MOC efficiency along the basilar membrane when routine clinical investigations lead one to suspect an involvement of this system, due to discordant damaging between inner and outer hair cells. Such studies would allow one to test the validity of hypotheses which invoke MOC-related mechanisms as an essential link for the emergence and persistence of tinnitus.- - - - - - - - - - ranking = 1.4847123507065E-5keywords = essential (Clic here for more details about this article) |
| | Next -> |