BackgroundSuperior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon (sound-induced vertigo) or Hennebert sign (valsalva-induced vertigo) due to the absence of bone overlying the SSC. We document a case series of elderly East Asian women with atypical SSCD symptoms, radiologically confirmed dehiscence and concurrent osteoporosis.MethodsA retrospective record review was performed on patients with dizziness, vertigo, and/or imbalance from a neurology clinic in a community health center serving the East Asian population in Boston. SSCD was confirmed by multi-detector, high-resolution CT of the temporal bone (with Pöschl and Stenvers reformations) and osteoporosis was documented by bone mineral density (BMD) scans.ResultsOf the 496 patients seen in the neurology clinic of a community health center from 2008 to 2010, 76 (17.3%) had symptoms of dizziness, vertigo, and/or imbalance. Five (6.6%) had confirmed SSCD by multi-detector, high-resolution CT of the temporal bone with longitudinal areas of dehiscence along the long axis of SSC, ranging from 0.4 to 3.0 mm, as seen on the Pöschl view. Two of the 5 patients experienced motion-induced vertigo, two fell due to disequilibrium, and one had chronic dizziness. None had a history of head trauma, otologic surgery, or active intracerebral disease. On neurological examination, two patients had inducible vertigo on Dix-Hallpike maneuver and none experienced cerebellar deficit, Tullio phenomenon, or Hennebert sign. All had documented osteoporosis or osteopenia by BMD scans. Three of them had definite osteoporosis, with T-scores < −2.5 in the axial spine, while another had osteopenia with a T-score of −2.3 in the left femur.ConclusionsWe describe an unusual presentation of SSCD without Tullio phenomenon or Hennebert sign in a population of elderly, East Asian women. There may be an association of SSCD and osteoporosis in this population. Further research is needed to determine the incidence and prevalence of this disorder, as well as the relationship of age, race, osteoporosis risk, and the development of SSCD.
The cytologic diagnoses in 49 body cavity fluids from 46 patients, of whom 30 had a clinical diagnosis of lymphoma or lymphatic leukemia, and 16 patients with benign inflammatory or reactive conditions, were compared to flow cytometric surface immunoglobulin light chain analysis (kappa-lambda analysis [KLA]). The results of both tests were correlated with clinical outcome and all available information from biopsy, autopsy, and additional cell marker studies. When the diagnoses by both cytologic analysis and KLA were in agreement (57.1% of cases), there were no false-negative or false-positive results. Overall, false-positive and false-negative rates were, respectively, 6.1% and 12.2% with cytologic study, and 4.1% and 4.1% with KLA. Sixteen samples were from patients with small lymphocytic lymphoma (CLL) and small cleaved lymphoma, which had a false-negative rate of 37.5% by cytologic study, and only 6.2% by KLA. There was one false-positive result by KLA among the benign effusions. These findings indicate that KLA is a powerful adjunct to the cytologic evaluation of lymphocyte-rich effusions, especially in cases of lymphoproliferative disorders characterized by small lymphocytes, in which the cytologic diagnosis is frequently difficult.
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