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Author: admin, 24.01.2016. Category: Cause Of Ringing In Ears

Myelogram –Used to identify lesions in the intradural or extradural compartments of the spinal canal by observing the flow of radiopaque dye through the subarachnoid space.
When a vascular disorder of the cochleovestibular system is considered, the diagnosis is based on exclusion of other diseases.
The aim of the investigation reported here was to diagnose cochleovestibular dysfunction in patients with vascular vertigo. In the neurootological department of Semmelweis University, we analyzed the data from 65 patients with vertebrobasilar insufficiency.
We performed a complete neurological examination, Doppler sonography, magnetic resonance imaging (MRI), and MR A, all of which verified the vascular origin and excluded space-occupying lesions and multiple sclerosis. Brainstem evoked response audiometry results were pathological except in approximately 16.8% of cases, or 11 of 65 (Table 3). Caloric weakness or canal paresis occurs in peripheral lesions, whereas directional preponderance is characteristic of central vestibular lesion. We examined the ratio of pathological findings of MRA, MRI, Doppler sonography of the internal carotid and vertebral arteries, brainstem evoked response audiometry, and otoneurology (Table 5). Vertebrobasilar ischemia can often be responsible for a wide range of central, peripheral, and combined vestibular syndromes. Auditory brainstem response and vestibular examination showed several lesions of brainstem function and labyrinthine function. Cochleovestibular system dysfunction can be considered to be vascular in origin if the examinations exclude other diseases, if the patients demonstrate vascular risk factors, and if other territories of the brain accessible for imaging methods show vascular disorders. Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary.
As arteries of the cochleovestibular system cannot be directly visualized, physicians must deduce vascular cochleovestibular disease from the vascular risk factors and vascular lesions of other territories.

Although the main vessels of the brainstem and the circle of Willis can be seen in angiograms, arteries of the cochleovestibular system cannot be observed with either transcranial Doppler sonography or magnetic resonance angiography (MRA). These arteries supply overlapping territories of the brainstem and cerebellum and the peripheral labyrinth via the labyrinthine artery [6].
In central lesions, the increased average slow-phase velocity of nystagmus is characteristic, owing to destroyed central inhibiting mechanisms.
As arteries of the cochleovestibular system cannot be visualized directly, we have to arrive at the diagnosis of vascular cochleovestibular disease on the basis of vascular risk factors and vascular lesions of other territories. In most of the patients we evaluated, we could observe multiple risk factors for cerebrovascular disorders. With my colleagues at Semmelweis University, I analyzed neurootological and audiological examination results in 65 patients with vascular vertigo. When cochleovestibular dysfunction of vascular origin is considered, diagnosis is based on exclusion of other diseases.
In labyrinthine infarction and in lateral pontomedullary infarction, a patient suffered from sensorineural hearing loss and, in all of these syndromes, suffered from vertigo. Patients with Meniere's disease, benign paroxysmal positional vertigo, multiple sclerosis, or intracranial space-occupying lesions were excluded from the study. We examined the cochleovestibular function of all patients by separate audiological and vestibular function tests.
In a few cases, typical positional nystagmus formed the basis of the diagnosis of central vestibular lesion, although the nystagmographic results were normal. In cerebrovascular patients, neurootological examination is the most sensitive procedure by which to evaluate vascular lesion of the brainstem.
Sudden sensorineural hearing loss associated with slow blood flow of the vertebrobasilar system.

Cochleovestibular system disorders can be considered to be of vascular origin if the examinations exclude other diseases, if the patients have vascular risk factors, and if other territories of the brain accessible for imaging methods show vascular disorders. Several authors have written about sensorineural hearing loss in cerebrovascular disorders [2-5]. The patients had occipital headache, minutes-long rotatory vertigo after head movement, drop attacks, occasional transient diplopia, and sensorineural hearing loss. Cochlear function tests included puretone audiometry, acoustic reflex threshold and decay, and brainstem evoked response audiometry.
In their reports, occlusion of small-caliber arteries due to severe arteriosclerosis or slow blood flow could be diagnosed. Some patients had vertiginous attacks that lasted a few days and were accompanied by vomitus, severe occipital headache, and perioral facial numbness. Vestibular tests included statokinetic tests, examination of spontaneous nystagmus, smooth-pursuit eye movement tests, and the bithermal caloric test. Although 20 patients had normal hearing, the detailed audiological examination results, including acousticofacial reflex patterns, were normal in only 18 patients. Most of the patients demonstrated several risk factors (Table 1); one-half had multiple risk factors that predisposed them to cerebrovascular diseases. Single-photon emission computed tomography of the brain was pathological in most of the patients with vertebrobasilar insufficiency.

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