Detection of Presumed Hemorrhage in the Ampullar Endolymph of the Semicircular Canal: A Case Report

Abstract

We examined a 61-year-old woman with sudden left-side hearing loss accompanied by severe vertigo. High signal in the ampullar endolymph of the left semicircular canal on magnetic resonance (MR) ‰uid attenuated inversion recovery (3D-FLAIR) images suggested labyrinthine hemorrhage. The patient had been treated for chronic heart failure and prescribed 100 mg/day of acetylsalicylic acid (aspirin) for its antiplatelet eŠect. The 3D-FLAIR images demonstrated a small amount of focal hemorrhage in the labyrinthine ‰uid that may have been overlooked on T 1 -weighted images.

Sudden Sensorineural Hearing Loss With Simultaneous Positional Vertigo Showing Persistent Geotropic Direction-Changing Positional Nystagmus

“…Findings obtained using three-dimensional fluidattenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) provided supporting evidence that a pathologic alteration occurs within the inner ear fluid in SSNHL patients with or without vertigo, in which high pre-contrast signals were observed within the inner ear on 3D-FLAIR (22,23). Pre-contrast high signals on 3D-FLAIR may reflect a minor hemorrhage or an increased inner ear concentration of proteins that were extravasated through blood vessels with increased permeability or originated from damaged cells in the inner ear (24).…”

The Technical and Clinical Features of 3D-FLAIR in Neuroimaging

“…[21][22][23][24][25][26][27][28][29][30] A FLAIR image allows the detection of subtle subarachnoid hemorrhage in the CSF space, 9 signal increases in CSF after the inhalation of oxygen, 31 and subtle compositional changes of the labyrinthine fluid (Figs. 6 and 7), 26,27,30,[32][33][34] which can be difficult to recognize on T 1 -weighted images. Heavily T 2 -weighted 3D-FLAIR has been reported to be much more sensitive than regularcontrast 3D-FLAIR.…”

“Light cupula” involving all three semicircular canals: A frequently misdiagnosed disorder

“…Recently, it was reported that the condition of the light cupula is responsible for the positional vertigo in some patients with sudden sensorineural hearing loss (SSNHL) [2]. Findings obtained using 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) in patients with SSNHL with vertigo indicated a minor hemorrhage or an increased concentration of proteins in the inner ear presumably due to a disruption of the blood-labyrinth barrier [10,11]. The blood-labyrinth barrier has been reported to be disrupted by various causes such as microcirculatory compromise, infection, and acoustic trauma [12][13][14].…”