We’ll continue on with the differential or list of possible diagnosis. Today we’ll explore options for when not only is the person complaining of dizziness, but also hearing difficulties. Please recall that some, but not all cerebellar strokes may have this feature. This possible diagnosis was mentioned in the last list, so I won’t re-hash it here.
Meniere’s disease: “Typically attacks start with a feeling of fullness in one ear, leading to progressive [ringing in the ear, one sided] fluctuating hearing loss and severe [spinning dizziness.] You’ll get a positive HIT on the effected ear. Over time, the attacks get less and less severe. Could also have “drop attacks” or sudden dizziness leading to an immediate fall.
Vertebrobasilar ischemia/brainstem stroke: These will have other brainstem neurological signs like slurred speech, problems controlling blood pressure, breathing and alertness. You could see bilateral hearing loss. All of this coming on VERY suddenly. Some people may have had brief episodes of these symptoms hours to days before a big episode happens.
Acoustic neuroma: These are more likely to show up with hearing loss that has gradually gotten worse over time and a ringing in the ear. The spinning dizziness is a less common sign.
Labyrinthine hemorrhage: This one is rare, but will have that spinning dizziness and deafness. You have to have imaging to confirm this, specifically a Tx weighted MRI will show “a hyperintense signal in the membranous labyrinth and cochlea […] with no change in signal on contrast administration.”
Short and sweet since I bet a lot of people are still out shopping today. Hope your Thanksgiving break has been great!
I’m currently in the midst of doing a literature review in preparation to write a case report. If you would like more background information on the case or information about the project, please click here. If you would like to see other article reviews related to this project, please click here.