椎骨動脈閉塞に合併したメニエール病確定診断例の1例

抄録

We report the case of a 52-year-old male patient who was diagnosed as having certain Meniere’s disease complicated by ipsilateral vertebral artery occlusion. The patient had undergone aortic arch replacement surgery in year X-6 due to thoracic aortic dissection. Postoperative contrast-enhanced CT revealed complete occlusion of the origin of the left vertebral artery and significant narrowing of the distal segment, although the patient remained asymptomatic. In year X, the patient experienced spontaneous non-spinning vertigo lasting for several hours and consulted a primary care physician. Clinical examination revealed spontaneous nystagmus to the right side and moderate sensorineural hearing loss on the left side. While vertebrobasilar insufficiency was suspected, the vertigo was not induced by positional changes, and MRI did not reveal acute ischemic changes. Due to the recurrent vertigo episodes and fluctuating unilateral sensorineural hearing loss, Meniere’s disease was considered in the differential diagnosis, and the patient was referred to our department. Electronystagmography showed no evidence of a central disease and caloric testing did not reveal semicircular canal paresis. Inner ear gadolinium-enhanced MRI revealed significant endolymphatic hydrops in the left vestibule and cochlea, meeting the diagnostic criteria for definite Meniere’s disease (left side). Conservative treatments led to improvements of both the vertigo and hearing loss. Although incidental ipsilateral vertebral artery occlusion and endolymphatic hydrops could have occurred independently, we considered it possible that blood flow impairment may have contributed to the secondary endolymphatic hydrops, manifesting as the clinical symptoms of Meniere’s disease.