Teaching Video NeuroImages: Intralabyrinthine schwannoma masquerading as Ménière disease

Lee, Sun-Uk; Kim, Hyojung; Choi, Jeong‐Yoon; Song, Jae-Jin; Choi, Byung-Se; Kim, Ji-Soo

doi:10.1212/wnl.0000000000009095

Cited by 2 publications

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References 2 publications

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“…The long duration of unilateral vestibular dysfunction (16 years in the current case) might help achieve good dynamic visual performance. Lee et al presented a case of ILS mimicking MD based on a positive vHIT result in all semicircular canals on the affected side ( 26 ). The causes of decreased VOR gains on the left anterior and posterior semicircular canals remain unknown.…”

Section: Discussionmentioning

confidence: 99%

Case report: Concurrent intravestibular schwannoma mimicking Ménière's disease and cochlear hydrops detected via delayed three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Nishimura

Murofushi²,

Hakuba³

2022

Front. Neurol.

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ObjectiveTo present a case of intralabyrinthine schwannoma (ILS) presenting as Ménière's disease diagnosed via 4-h delayed gadolinium-enhanced three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) and treated successfully using the translabyrinthine approach.PatientA patient who was diagnosed with intravestibular ILS.InterventionsThe patient underwent comprehensive preoperative neurological examinations and MRI. The tumor was resected using the translabyrinthine approach and was pathologically confirmed as schwannoma based on the surgical specimen.Main outcome measuresPreoperative audiogram and vestibular test findings and MRI images.ResultsPreoperatively, pure-tone audiogram showed progressive sensorineural hearing loss only on the affected side. The video head impulse test and vestibular evoked myogenic potential test showed vestibular dysfunction on the affected ear. Immediate gadolinium-enhanced T1-weighted MRI revealed an enhanced region in the vestibule. Meanwhile, magnetic resonance cisternography showed a filling defect. Delayed 3D-FLAIR MRI revealed a signal void in the scala media of the cochlea indicative of cochlear hydrops, and a strong signal in the perilymph at the basal cochlea suggestive of impaired blood–labyrinthine barrier.ConclusionDelayed 3D-FLAIR MRI is useful in diagnosing concurrent ILSs and endolymphatic hydrops.

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Section: Discussionmentioning

confidence: 99%

Case report: Concurrent intravestibular schwannoma mimicking Ménière's disease and cochlear hydrops detected via delayed three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Nishimura

Murofushi²,

Hakuba³

2022

Front. Neurol.

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Evolution of Vestibular Findings During and Between the Attacks of Meniere Disease

Lee,

Park,

Kim

et al. 2024

Neur Clin Pract

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Purpose of ReviewThe diagnosis of Meniere disease (MD) has based on characteristics of vertigo and findings of audiologic evaluation. This review focuses on the recent findings of the evolution of vestibular function and their underlying physiology during and between the attacks of MD and thus aims to help identify this common disorder with many faces according to the phase. Recent FindingsDuring the attacks, the direction of spontaneous nystagmus changes over time, beating initially toward the affected ear (irritative nystagmus), then toward the healthy ear (paretic nystagmus), and finally back toward the affected ear again (recovery nystagmus). Apart from these direction changes, atypical forms of spontaneous nystagmus, such as downbeat, discordant horizontaltorsional, and aperiodic alternating nystagmus, can be observed. Head impulse tests (HITs) are mostly normal during the irritative/recovery phases, but positive in more than half of patients during the paretic phase. By contrast, caloric tests are usually abnormal irrespective of the phases, although paradoxical caloric hyper-responsiveness can be observed in 18% of patients during the irritative/recovery phases. Thus, dissociation in the findings of caloric tests-HITs can be observed during and between the attacks. Horizontal head shaking tends to augment spontaneous nystagmus during each phase, while skull vibration mostly induces nystagmus beating toward the healthy ear irrespective of the phases. During the attacks, ocular vestibularevoked myogenic potentials (VEMPs) may be enhanced, whereas cervical VEMPs are usually decreased during stimulation of the involved ear.

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Teaching Video NeuroImages: Intralabyrinthine schwannoma masquerading as Ménière disease

Cited by 2 publications

References 2 publications

Case report: Concurrent intravestibular schwannoma mimicking Ménière's disease and cochlear hydrops detected via delayed three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Case report: Concurrent intravestibular schwannoma mimicking Ménière's disease and cochlear hydrops detected via delayed three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Evolution of Vestibular Findings During and Between the Attacks of Meniere Disease

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