We report a patient with vertigo and sudden hearing loss due to acute disseminated encephalomyelitis (ADEM).
A 17-year-old male complained of sudden hearing loss in the right ear and dizziness subsequent to symptoms resembling those of a common cold. To his recall, he had never manifested any previous neurological disturbances. Audiometric testing revealed severe sensorineural hearing loss in his right ear and mild sensorineural hearing loss in his left ear. In addition, a short increment sensitivity index (SISI) test was positive bilaterally. Neuro-otological examinations revealed horizontal-rotating nystagmus and upbeat nystagmus on positional and/or positioning nystagmus tests. Although pursuit eye movement was normal, the optokinetic nystagmus was impaired and fast-phase velocity of the nystagmus was reduced. Caloric tests revealed severe hypofunction bilaterally. MRI showed patchy high-intensity areas in the pons, left frontal lobe, left superior frontal gyrus, and left parietal lobe on T2-weighted and FLAIR (fluid attenuated inversion recovery) images.
Based on the history, physical examinations, laboratory tests, and MRI findings for this patient, he was diagnosed as having ADEM with bilateral inner ear lesions. This patient was considered to be an unusual case of ADEM complicated with cochlear and vestibular signs. To our knowledge, such a case has not been previously reported.
