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Clinical Challenge
Radiology
March 14, 2019

Central Vertigo and Hearing Loss in an African Swimmer

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
  • 2Laboratory of Anatomy and Cell Biology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Mons, Belgium
JAMA Otolaryngol Head Neck Surg. 2019;145(5):475-476. doi:10.1001/jamaoto.2018.3904

A 46-year-old African swimmer presented with a 1-month history of progressive left hearing loss and vertigo. He also reported asthenia, sleep disorders, and urinary frequency. The urinary frequency has been treated for 2 years with many drugs (tamsulosin, desmopressin, and solifenacin) without improvement. The patient had spent his childhood in eastern Africa, where he swam in Lake Tanganyika. His history did not reveal trauma, infection, or any other associated conditions at the onset of the complaints. The ear, nose, and throat examination revealed a right horizontal nystagmus and a poorly delineated hypoesthesia of the left pinna. He could not walk properly owing to his vertigo. The rest of the clinical examination findings were unremarkable. Additional examinations (ie, pure-tone audiometry, video nystagmography, tympanometry) revealed left profound hearing loss with an air-bone gap of 40 dB and central vertigo. Otoacoustic emissions were absent on the left side. There was no left acoustic reflex. Auditory brainstem responses showed asymmetric interpeak latencies of waves I through V and III through V, suggesting slower conduction on the left side. Computed tomography and cerebral magnetic resonance imaging (MRI) revealed a 24 × 20-mm hemorrhagic lesion in the left middle cerebellar peduncle associated with a thickening of the cochleovestibular nerve (Figure). The patient was referred to urology, where a 13 × 8-mm mass was discovered in the lateral wall of the prostate gland. Biopsies of prostate and brain lesions, blood tests, and urinalysis were performed.

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