Pseudo-vestibular neuritis caused by brainstem lesion

Abstract We report herein the case of a 17-year-old female who presented with intracranial hypertension and diplopia. Magnetic resonance imaging showed a large left cystic and solid temporoparietal lesion, associated with an infiltrating lesion of the brainstem, hypointense in T1 and hyperintense in FLAIR sequences, without enhancement after injection of gadolinium. Complete resection of the parietal mass and biopsy of the brainstem lesion were performed. Histopathological analysis of the parietal mass showed glioblastoma (WHO grade IV) with no IDH1/2 or H3.3/H3.1 gene mutation detected by Sanger sequencing. Immunohistochemistry found the expression of the proteins of mismatch repair system. Whole exome and RNA sequencing identified a BRAF-V600E mutation. The brainstem lesion was a diffuse midline glioma, H3K27M-mutant (grade IV) according to the 2016 WHO classification. Pan-genomic SNP arrays of the 2 tumors showed distinct genetic alterations. The parietal glioblastoma displayed complex genomic alterations whereas the brainstem glioma harbored chromosome 7q gain, chromosome 9p and 10 losses, and RB, TP53 and CDKN2A homozygous deletions. The patient was treated by concomitant radiochemotherapy (according to Stupp protocol). After 12 cycles of temozolomide, there was complete remission persistant in the parietal lobe. The brainstem tumor was stable but progressed after 3 months of temozolomide discontinuation. Treatment with mTOR inhibitors was initiated. At 21-month follow-up, the patient remains with few symptoms. No predisposition syndrome was identified in the patient or her family. Concurrent glioblastomas with distinct driver gene mutations are exceptional.

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Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x211013261 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110132

Author(s):

Alexandra Halalau ◽

Madalina Halalau ◽

Christopher Carpenter ◽

Amr E Abbas ◽

Matthew Sims

Keyword(s):

Case Report ◽

Severe Acute Respiratory Syndrome ◽

Medical History ◽

Cranial Nerve ◽

Respiratory Illness ◽

Vestibular Neuritis ◽

Past Medical History ◽

Significant Past Medical History ◽

Eighth Cranial Nerve ◽

Male Physician

Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.

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The Interrelations Between Different Causes of Dizziness: A Conceptual Framework for Understanding Vestibular Disorders

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419845014 ◽

2019 ◽

Vol 128 (9) ◽

pp. 869-878 ◽

Cited By ~ 7

Author(s):

Richard T. Zhu ◽

Vincent Van Rompaey ◽

Bryan K. Ward ◽

Raymond Van de Berg ◽

Paul Van de Heyning ◽

...

Keyword(s):

Conceptual Framework ◽

Meniere’S Disease ◽

Vestibular Migraine ◽

Menière’S Disease ◽

Vestibular Neuritis ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Vestibular Disorders ◽

Menière's Disease ◽

Ménière's Disease

Background:According to population-based studies that estimate disease prevalence, the majority of patients evaluated at dizziness clinics receive a single vestibular diagnosis. However, accumulating literature supports the notion that different vestibular disorders are interrelated and often underdiagnosed.Objective:Given the complexity and richness of these interrelations, we propose that a more inclusive conceptual framework to vestibular diagnostics that explicitly acknowledges this web of association will better inform vestibular differential diagnosis.Methods:A narrative review was performed using PubMed database. Articles were included if they defined a cohort of patients, who were given specific vestibular diagnosis. The interrelations among vestibular disorders were analyzed and placed within a conceptual framework.Results:The frequency of patients currently receiving multiple vestibular diagnoses in dizziness clinic is approximately 3.7% (1263/33 968 patients). The most common vestibular diagnoses encountered in the dizziness clinic include benign paroxysmal positional vertigo (BPPV), vestibular migraine, vestibular neuritis, and Ménière’s disease.Conclusions:A review of the literature demonstrates an intricate web of interconnections among different vestibular disorders such as BPPV, vestibular migraine, Ménière’s disease, vestibular neuritis, bilateral vestibulopathy, superior canal dehiscence syndrome, persistent postural perceptual dizziness, anxiety, head trauma, and aging, among others.

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