Hiroya Fujiki

A Case Report of Medullary Infarction with Vertigo in a Young Adult.

It is generally known that cerebral infarction commonly occurs in elderly people. Rarely, cerebral infarction may occur in young adults due to complications such as collagen disease, heart disease, and dissecting aneurysm. We recently encountered a 32-year-old man who had occasionally complained of occipital pain after drinking alcohol since April 1999. As he also experienced sudden onset of vertigo with occipital pain, he went to the Department of Otolaryngology, Takarazuka City Hospital on April 14, 1999. Left-ward horizontal-rotatory spontaneous nystagmus was presented as shown in vestibular dysfunction. There were not any cerebellar signs, but left trigeminal hypesthesia suggested a central nervous system disorder. Moreoever, we found disturbances of touch, temperature, and pain sensations on the right upper and lower extremities.MRI showed an infarction in the left lateral medulla oblongata. Vertebral angiography showed an aneurysm in the distal and proximal segments of the left posterior inferior cerebellar artery. These findings indicated that medullary infarction was caused by dissecting aneurysm of the vertebral artery.In the present case, it was suggested that the intima of the vertebral artery rapidly deteriorated due to the dehydration resulting from excessive alcohol intake, and that neurological examination should be performed even in juvenile vertiginous cases.

Magnetic Resonance Angiography for Patients with Positional Vertigo.

Magnetic resonance angiography (MRA) can image the blood vessels without invasion. Using MRA, we studied the vascular morphology of the vertebral artery in patients with positional nystagmus and vertigo. Fifteen patients without vestibular disorder such as benign positional vertigo were examined. Six cases underwent conventional vertebral angiograpy, including digital subtraction angiography (DSA) for comparison with MRA.In all cases, we observed the vertebral artery from the bifurcation to the basilar artery with MRA. In 12 cases, abnormal findings of elongation, bending, narrowing or obstruction of the vertebral artery were found. In five cases, arterial compression and elongation increased in association with head rotation. A difference in the vessel diameter on each side was observed in 4 cases. Accordingly, some abnormal vessels were found in 14 of 15 cases in our study. This rate was very close to previous resolts obtained with conventional angiography.In two cases, MRA findings differed from conventional angiography due to peculiar artifacts of MRA. Therefore, MRA may be the first choice for the patients with vertigo, followed by conventional angiography, if necessary.

Report of a Patient with Bilateral Secretory Otitis Mediafollowed by Bilateral Sudden Deafness of Viral Origin

A case of bilateral serous otitis media followed by bilateral sudden deafness and right facial paresis in a 58-year-old woman is described. When she visited us on October 2, bilateral serous otitis media and sensorineural hearing loss were diagnosed otoscopically and audiometrically. Steroid therapy had been begun 14 weeks previously when she had had left ear fullness which brought her to an otologist, though she could not continue adequate therapy. Ten weeks later (in the beginning of September), she noticed right hearing loss and tinnitus, and was diagnosed as having bilateral sudden deafness. On October 30, right facial paresis developed. The Herpes simplex titer was 4 on October 2, 128 on October 30. Facial weakness recovered completely after 2 weeks, left hearing loss recovered almost completely before the end of December but right hearing loss was marked.