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Clinical Problem Solving: Radiology
June 2009

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

C. DOUGLASPHILLIPSMD

Arch Otolaryngol Head Neck Surg. 2009;135(6):614. doi:10.1001/archoto.2009.39-b

Although the majority of cases diagnosed as sudden sensorineural hearing loss (SSNHL) are grouped in the diagnostic category of idiopathic, an investigation into the known causes of SSNHL should be undertaken. Viral labyrinthitis, vascular causes, neoplasms, autoimmune diseases, trauma, and toxic drug reactions are all potential pathogenetic factors that should be investigated before the conclusion is reached that the hearing loss is idiopathic. Labyrinthine hemorrhage has been associated with sickle cell disease,1chronic myelogenous leukemia,2systemic lupus erythematosus,3endolymphatic sac tumors,46and the use of anticoagulants.7Radiographic diagnosis is characterized by high signal intensity of the labyrinth on noncontrast T1-weighted MRIs (Figures 1 and 2) and T2-weighted fluid-attenuated inversion recovery MRIs.8T2-weighted MRIs demonstrate variable signal intensity of the affected labyrinth in the setting of intralabyrinthine hemorrhage (Figure3). In contrast, a mass such as a lipoma would result in low signal intensity on T2-weighted MRIs. The high signal intensity on noncontrast T1-weighted MRIs that is characteristic of intralabyrinthine hemorrhage has been shown to persist for approximately 6 months owing to the extended life span of erythrocytes in cerebrospinal fluid.9

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