Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia

Abstract

Objectives. Vertebrobasilar dolichoectasia (VBD), an elongation and distension of vertebrobasilar artery, may present with cranial nerve symptoms due to nerve root compression. The objectives of this study are to summarize vestibulocochlear manifestations in subjects with VBD through a case series and to discuss the needs of thorough oto-neurotologic evaluation in VBD subjects before selecting treatment modalities.Methods. Four VBD subjects with vestibulocochlear manifestations were reviewed retrospectively. VBD was confirmed by either brain or internal auditory canal magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Patient information, medical history, MRI/MRA findings, and audiometry or vestibular function tests were reviewed according to patient’s specific symptom.Results. Of the four subjects, three presented with ipsilesional sensorineural hearing loss (SNHL), three with paroxysmal recurrent vertigo, and two with typewriter tinnitus. The MRI/MRA of the four subjects revealed unilateral VBD with neurovascular compression of cisternal segment or the brainstem causing displacement, angulation, or deformity of the cranial nerve VII or VIII that corresponded to the symptoms.Conclusion. Vestibulocochlear symptoms such as SNHL, recurrent paroxysmal vertigo, or typewriter tinnitus can be precipitated from a neurovascular compression of the vestibulocochlear nerve by VBD. Because proper medical or surgical treatments may stop the disease progression or improve audio-vestibular symptoms in subjects with VBD, a high index of suspicion and meticulous radiologic evaluation are needed when vestibulocochlear symptoms are not otherwise explainable, and if VBD is confirmed to cause audiovestibular manifestation, a thorough oto-neurotologic evaluation should be performed before initial treatment.

Longitudinal analysis of surgical outcome in subjects with pulsatile tinnitus originating from the sigmoid sinus

“…In this study, after SS resurfacing/reshaping, short-term (< 1 week) and long-term (> 1 year) changes in subjective symptoms were analyzed in all patients. The severity of PT was assessed subjectively by qualifying the loudness and annoyance of tinnitus via VAS ranging from 0 to 10 34 , 35 . All questionnaires were delivered the day before the operation, and during short-term (< 1 week) and long-term (> 1 year) follow-ups.…”

Cortical Oscillatory Signatures Reveal the Prerequisites for Tinnitus Perception: A Comparison of Subjects With Sudden Sensorineural Hearing Loss With and Without Tinnitus

“…The hearing thresholds for seven different octave frequencies (0.25, 0.5, 1, 2, 3, 4, and 8 kHz) were evaluated using pure-tone audiometry in a soundproof booth. The mean hearing threshold was calculated using the average of the hearing thresholds at 0.5, 1, 2, and 4 kHz (Han et al, 2019;Shim et al, 2019;Bae et al, 2020;Huh et al, 2020;Lee et al, 2020b;Song et al, 2020). At each subject's initial visit, we obtained a structured history of the characteristics of tinnitus including its presence, laterality, and psychoacoustic nature (pure-tone or narrow-band noise).…”

<p>Vertebrobasilar Dolichoectasia as a Rare Cause of Simultaneous Abducens and Vestibulocochlear Nerve Symptoms: A Case Report and Literature Review</p>

“…6,7,17,18 It is notable that multiple cranial nerve involvement in patients with VBD is rarely reported. [7][8][9] Madhugiri et al 8 described a patient with diplopia owing to a left abduction deficit, together with ipsilateral facial pain and facial muscle twitches, attributed to compression of the abducens, trigeminal and facial nerves caused by VBD, respectively. Pham et al 7 reported a similar case, in which VBD resulting in both abducens and ipsilateral trigeminal nerve palsies.…”

“…6,7 In contrast, abducens, trochlear, vestibular, glossopharyngeal or vagus nerve impairment caused by neurovascular compression of VBD is uncommon. [7][8][9][10][11][12] Notably, multiple cranial nerve involvement in patients with VBD is extremely rare. [7][8][9] Herein, we present a case of a 33-year-old patient with symptoms of the abducens and vestibulocochlear cranial nerves which were relieved by antihypertensive therapy.…”

“…[7][8][9][10][11][12] Notably, multiple cranial nerve involvement in patients with VBD is extremely rare. [7][8][9] Herein, we present a case of a 33-year-old patient with symptoms of the abducens and vestibulocochlear cranial nerves which were relieved by antihypertensive therapy. To the best of our knowledge, simultaneous abducens and vestibulocochlear nerve symptoms precipitated by VBD compression have not yet been reported.…”