We report a case with ipsilateral delayed endolymphatic hydrops (DEH) who presented with a vertigo attack caused by contralateral acute unilateral vestibular syndrome. Gadolinium-enhanced inner ear magnetic resonance imaging (ieMRI) was useful for diagnosing the causative pathology in this case.
A 44-year-old male patient visited our emergency department complaining of a spontaneous and sustained vertigo attack. He had suffered from hearing loss in his right ear from childhood. He had also been suffering from recurrent vertigo attacks for 15 years and been diagnosed as having ipsilateral DEH.
He was hospitalized and received intravenous methylprednisolone treatment (total dose, 400 mg). His left ear showed a slight threshold shift as compared to five years earlier, although the patient was not clearly aware of it; he also failed to improve with the steroid treatment. The vertigo resolved within a week. Vestibular examination showed novel dysfunctions in the left ear; significant catch up saccades evoked by stimulation of all three semicircular canals in the bedside head impulse test and moderate canal paresis in the caloric test, although cervical and ocular vestibular evoked myogenic potentials showed no abnormalities. Furthermore, an ieMRI revealed significant endolymphatic hydrops in the vestibule and cochlear only in the right ear.
The patient was diagnosed as having acute vestibulo-cochlear dysfunction, and the possibility of contralateral DEH was excluded based on the results of the examinations. Inner ear MRI may be useful to evaluate the clinical pathology in cases of acute vestibular syndrome, even in cases with a history of DEH.
