Orthostatic hearing loss: audiovestibular manifestations of spontaneous intracranial hypotension

2020 ◽  
pp. practneurol-2019-002479
Author(s):  
Frederick Schon ◽  
Arun Karunakaran ◽  
Sarah Shanmuganathan ◽  
Arani Nitkunan
Keyword(s):  
Cerebrospinal Fluid ◽  
Hearing Loss ◽  
Inner Ear ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
The Other ◽  
Bilateral Hearing Loss ◽  
Inner Ear Fluids

A 36-year-old woman with severe postural headaches caused by spontaneous intracranial hypotension developed bilateral hearing loss. Her hearing loss varied in severity and also at times affected one ear more than the other. She noticed her hearing returned to normal on lying flat, and this was confirmed on audiometry. Her hearing fully recovered after treatment with blood patches. Audiovestibular symptoms affect up to 70% of people with spontaneous intracranial hypotension but are probably under-reported. Cerebrospinal fluid and inner ear fluids are related in two separate channels: the vestibular and the cochlear aqueducts. We discuss their role in the postural hearing loss of spontaneous intracranial hypotension.

Na and nonelectrolyte entry into inner ear fluids of the rat

1987 ◽  
Vol 253 (1) ◽  
pp. F50-F58 ◽  
Author(s):  
O. Sterkers ◽  
E. Ferrary ◽  
G. Saumon ◽  
C. Amiel
Keyword(s):  
Cerebrospinal Fluid ◽  
Inner Ear ◽  
Lateral Ventricle ◽  
Endothelial Barrier ◽  
Scala Tympani ◽  
Epithelial Secretion ◽  
Kinetics Of ◽  
Hydrophilic Solutes ◽  
Inner Ear Fluids ◽  
Scala Vestibuli

Kinetics of hydrophilic solute entry into endolymph (EL), perilymph (PL), and cerebrospinal fluid (CSF) were studied after intravenous administration (sodium, urea, glycerol, mannitol, sucrose) and cerebral lateral ventricle injection (urea, sucrose) of tracers in anesthetized rats. Samples of cochlear EL, PL of scala vestibuli (PLV), PL of scala tympani (PLT), and cisternal CSF were obtained. The data showed slow entry of tracers in PLV, PLT, and CSF as follows: Na greater than urea greater than mannitol approximately sucrose; slower entry of mannitol and sucrose in PLT and CSF than in PLV; 1 h delayed peak of radioactivity in PLV compared with the immediate peaks in PLT and CSF after CSF injection, and the value of PLV peak was 13% that in CSF; extremely slow entry of nonelectrolytes in EL. These results indicate that PLV originates mainly from plasma across a blood-perilymph barrier that restricts the entry of small hydrophilic solutes. The blood-perilymph barrier is most likely composed of an endothelial barrier associated with an epithelial secretion. The latter could be located at the vasculo-epithelial zone of the spiral limbus.

Brain volume changes in spontaneous intracranial hypotension: Revisiting the Monro-Kellie doctrine

Cephalalgia ◽  
2020 ◽  
pp. 033310242095038
Author(s):  
Jr-Wei Wu ◽  
Yen-Feng Wang ◽  
Shu-Shya Hseu ◽  
Shu-Ting Chen ◽  
Yung-Lin Chen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Tissue ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Fluid Volume ◽  
Tissue Volume ◽  
Fixed Constant ◽  
The Brain ◽  
Cerebrospinal Fluid Volume

Objectives In the application of the Monro-Kellie doctrine in spontaneous intracranial hypotension, the brain tissue volume is generally considered as a fixed constant. Traditionally, cerebral venous dilation is thought to compensate for decreased cerebrospinal fluid. However, whether brain tissue volume is invariable has not yet been explored. The objective of this study is to evaluate whether brain tissue volume is fixed or variable in spontaneous intracranial hypotension patients using automatic quantitative methods. Methods This retrospective and longitudinal study analyzed spontaneous intracranial hypotension patients between 1 January 2007 and 31 July 2015. Voxel-based morphometry was used to examine brain volume changes during and after the resolution of spontaneous intracranial hypotension. Brain structure volume was analyzed using Statistical Parametric Mapping version 12 and FMRIB Software Library v6.0. Post-treatment neuroimages were used as surrogate baseline measures. Results Forty-four patients with spontaneous intracranial hypotension were analyzed (mean [standard deviation] age, 37.8 [8.5] years; 32 female and 12 male). The whole brain tissue volume was decreased during spontaneous intracranial hypotension compared to follow-up (1180.3 [103.5] mL vs. 1190.4 [93.1] mL, difference: −10.1 mL [95% confidence interval: −18.4 to −1.8 mL], p = 0.019). In addition, ventricular cerebrospinal fluid volume was decreased during spontaneous intracranial hypotension compared to follow-up (15.8 [6.1] mL vs. 18.9 [6.9] mL, difference: −3.2 mL [95% confidence interval: −4.5 to −1.8 mL], p < 0.001). Longer anterior epidural cerebrospinal fluid collections, as measured by number of vertebral segments, were associated with greater reduction of ventricular cerebrospinal fluid volume (Pearson’s r = −0.32, p = 0.036). Conclusion The current study found the brain tissue volume and ventricular cerebrospinal fluid are decreased in spontaneous intracranial hypotension patients. The change in ventricular cerebrospinal fluid volume, but not brain tissue volume change, was associated with the severity of spinal cerebrospinal fluid leakage. These results challenge the assumption that brain tissue volume is a fixed constant.

scholarly journals Inner Ear Conductive Hearing Loss and Unilateral Pulsatile Tinnitus Associated with a Dural Arteriovenous Fistula: Case Based Review and Analysis of Relationship between Intracranial Vascular Abnormalities and Inner Ear Fluids

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Ettore Cassandro ◽  
Claudia Cassandro ◽  
Giuliano Sequino ◽  
Alfonso Scarpa ◽  
Claudio Petrolo ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Arteriovenous Fistula ◽  
Inner Ear ◽  
Dural Arteriovenous Fistula ◽  
Conductive Hearing Loss ◽  
Pulsatile Tinnitus ◽  
Vascular Abnormalities ◽  
First Case ◽  
Conductive Hearing ◽  
Inner Ear Fluids

While pulsatile tinnitus (PT) and dural arteriovenous fistula (DAVF) are not rarely associated, the finding of a conductive hearing loss (CHL) in this clinical picture is unusual. Starting from a case of CHL and PT, diagnosed to be due to a DAVF, we analyzed relationship between intracranial vascular abnormalities and inner ear fluids. DAVF was treated with endovascular embolization. Following this, there was a dramatic recovery of PT and of CHL, confirming their cause-effect link with DAVF. We critically evaluated the papers reporting this association. This is the first case of CHL associated with PT and DAVF. We describe the most significant experiences and theories reported in literature, with a personal analysis about the possible relationship between vascular intracranial system and labyrinthine fluids. In conclusion, we believe that this association may be a challenge for otolaryngologists. So we suggest to consider the possibility of a DAVF or other AVMs when PT is associated with CHL, without alterations of tympanic membrane and middle ear tests.

Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension – a consecutive cohort study

Cephalalgia ◽  
2018 ◽  
Vol 39 (2) ◽  
pp. 306-315 ◽  
Author(s):  
Jens Fichtner ◽  
Christian T Ulrich ◽  
Christian Fung ◽  
Debora Cipriani ◽  
Jan Gralla ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Sheath ◽  
Fluid Leak

Objective Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. Methods We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016. The systematic workup included: Optic nerve sheath diameter sonography, spinal MRI and dynamic myelography with subsequent CT. Microsurgical sealing of the cerebrospinal fluid leak was the aim in all cases. Results Of 29 patients with a proven cerebrospinal fluid leak, one declined surgery. A single patient was lost to follow-up. In 27 cases, the cerebrospinal fluid leak was successfully sealed by microsurgery. The width of the optic nerve sheath diameter in supine position increased from 5.08 ± 0.66 mm before to 5.36 ± 0.53 mm after surgery ( p = 0.03). Comparing the response of the optic nerve sheath diameter to gravitational challenge, there was a significant change from before (−0.36 ± 0.32 mm) to after surgery (0.00 ± 0.19 mm, p < 0.01). In parallel, spontaneous intracranial hypotension-related symptoms resolved in 26, decreased in one and persisted in a single patient despite recovery of gait. Conclusions The sonographic assessment of the optic nerve sheath diameter with gravitational challenge can distinguish open from closed spinal cerebrospinal fluid fistulas in spontaneous intracranial hypotension patients. A response to the gravitational challenge, that is, no more collapse of the optic nerve sheath while standing up, can be seen after successful treatment and correlates with the resolution of clinical symptoms. Sonography of the optic nerve sheath diameter may be utilized for non-invasive follow-up in spontaneous intracranial hypotension.

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