R. NICKBRYANMDS. JAMESZINREICHMD
A 48-YEAR-OLD WHITE WOMAN presented with intermittent, brief vertiginous episodes that had been progressively increasing in frequency over 2 to 3 years. Bilateral aural fullness was noted, more in the right ear than the left. The patient had been treated for recurrent bilateral acute otitis externa 4 times during the previous year. She denied complaints of hearing loss, tinnitus, otalgia, or otorrhea. She had no history of trauma, otitis media, meningitis, or exposure to ototoxins, and her medical history and family history were noncontributory. She underwent a complete head and neck examination, neurologic examination, and electronystagmography. Right caloric weakness of 36% and spontaneous lateral gaze nystagmus were noted. The findings of tympanometry and audiometry were normal, and her speech discrimination was excellent bilaterally. The results of laboratory investigations, including antinuclear antibody titers, erythrocyte sedimentation rate, rheumatoid factor, serologic tests for syphilis, complete blood cell count, and thyroid profile, were normal. Computed tomographic (CT) scans of the temporal bones (Figure 1) and magnetic resonance imaging (MRI) scans of the head, with and without gadolinium enhancement, were obtained (Figure 2, Figure 3, and Figure 4). Renal ultrasonography revealed no abnormalities.
Shaw EA, Antonelli PJ. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2003;129(1):129. doi:10.1001/archotol.129.1.129