Gyrus Daily Questions; Internal Medicine #44

[cingulate.gyrus]

For the last 5 weeks a 35-year-old female has had epi-sodes of intense vertigo that last several hours. Each epi-sode is associated with tinnitus and a sense of fullness in the right ear; during the attacks she prefers to lie on the left side. Examination during an attack shows that she has fine rotary nystagmus that is maximal on gaze to the left.
There are no ocular palsies, cranial nerve signs, or long-tract signs. An audiogram shows high-tone hearing loss in the right ear, with recruitment but no tone decay. The most likely diagnosis in this case is

A. labyrinthitis
B. Ménière’s disease
C. vertebral-basilar insufficiency
D. acoustic neuroma
E. multiple sclerosis

[step_enhancer]

Answer B............

[K06100]

B. Ménière’s disease

[aknz]

B. Ménière’s disease

Vertigo,tinnitis and hearing loss.

[ajaja]

(B) Meniere's disease - Vertigo, tinnitus and hearing loss

[rise]

its B : vertigo , tinnitus, fullness and hearing loss

[Anders]

Would be B

[Novobiocin]

Would go with B but Ménière’s disease usually have low frequency hearing loss.
Also, acoustic neuroma can have ear fullness and a high frequency hearing loss.

[Vaiting]

Originally Posted by novobiocin

Would go with B but Ménière’s disease usually have low frequency hearing loss.
Also, acoustic neuroma can have ear fullness and a high frequency hearing loss.

I would agree with the mention of high frequency loss possibly ruling out Menieres - recalled this from a line in First Aid CK a while back... I've never caught it elsewhere I think (at least with gradual low frequency)

Of what minimal resources I have, I couldn't find a usmle review book that mentions specifically a relation of "high frequency hearing loss and acoustic neuroma", from some auditory-type of test for example -

Novobiocin (or someone else), was this discussed from another question or review book? So that I can check it out... a quick glance over e-medicine (link below) didn't catch anything specific to that association.

http://emedicine.medscape.com/articl...overview#a0112

[cingulate.gyrus]

The answer is B.

The symptoms and signs described in this question are most consistent with Ménière’s disease.

In this disorder paroxysmal vertigo resulting from labyrinthine lesions is associated with nausea, vomiting, rotary nystagmus, tinnitus, high-tone hearing loss with recruitment, and, most characteristically, fullness in the ear.

Labyrinthitis would be an unlikely diagnosis in this case because of the hearing loss and multiple episodes.

Vertebral-basilar insufficiency and multiple sclerosis typically are associated with brainstem signs.

Acoustic neuroma only rarely causes vertigo as the initial symptom, and the vertigo it does cause is mild and intermittent.