Abstract
Introduction Intralabyrinthine haemorrhage is a rare cause of sudden sensorineural hearing loss (SNHL) associated with an acute vestibular syndrome (AVS).
Case Report A 45-year-old female with a history of stable migraine with aura, presented with an AVS with simultaneous sudden SNHL and tinnitus without preceding viral symptoms. Examination revealed a positive left bedside head impulse test and left SNHL. Pure tone audiometry (PTA) revealed profound left SNHL. Video head impulse testing revealed significantly reduced vestibular-ocular reflex gain with catch-up saccades of the left posterior semicircular canal. Comprehensive vestibular testing revealed widespread left vestibular failure. Blood evaluation revealed mild lymphopenia but normal coagulation studies, inflammatory markers, vasculitic, autoimmune and pro-thrombotic testing. Computed tomography angiogram of head and neck and magnetic resonance imaging (MRI) brain with diffusion-weighted imaging (DWI) performed within 24-hours of symptom onset were normal. MRI of the internal auditory meatus (IAM) on day 7 revealed increased T1 and fluid-attenuated inversion recovery (FLAIR) signal in the left cochlea and semicircular canals, with no post-contrast enhancement. She was initially treated with oral prednisolone and valciclovir. Intratympanic steroids were given at 2, 3 and 4 weeks. Vestibular symptoms had improved by day 7 but at her 3-months follow-up she remained profoundly deaf in that ear and will be evaluated for cochlear implant candidacy.
Conclusion Identifying patients having an intralabyrinthine haemorrhage in the context of an AVS is important as it carries a poor prognosis. All patients with acute vertigo with sudden SNHL should be considered for urgent MRI of the labyrinth.
