Research in Vestibular Science

Case Reports

Acute Vestibular Syndrome Preceded by Otologic Symptoms in Sarcoidosis: Hyeon-Joong Park, Jae-Myung Kim, Han-Sol Choi, Taebum Lee, Seung-Han Lee; Res Vestib Sci. 2021;20(2):69-73. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.69

Abstract PDF Supplementary Material: Sarcoidosis is a rare, multisystem granulomatous disease. Neurological complications occur in about 5% of patients and vestibulocochlear involvement is even rarer. A 27-year-old woman presented with acute spontaneous vertigo for 5 days. She was diagnosed with pulmonary sarcoidosis 4 months ago, but specific treatments have not yet started. She had preceding otologic symptoms including bilateral tinnitus and ear fullness in the right for 3 months without hearing loss. Initial bedside examinations revealed spontaneous right-beating nystagmus and abnormal catch-up saccades in the left during head impulse tests (HIT). After 2 weeks, video-oculography documented the direction of spontaneous nystagmus was changed into left-beating. Caloric test showed canal paresis in the left, and video HIT showed subtle covert saccades. After starting oral prednisolone, her symptoms improved rapidly. In our case, acute vestibular syndrome and otologic symptoms might be associated with sarcoidosis when considering clinical course and treatment response. Sarcoidosis may be considered as a cause in cases with audiovestibulopathy of unknown etiology.

Unilateral Vestibular Neuritis after Snakebite: Is There a Causal Relationship?: Jae-Myung Kim, Hyeon-Joong Park, Shina Kim, Seung-Han Lee; Res Vestib Sci. 2020;19(4):144-148. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.144

Abstract PDF: Vast majority of triggering factors preceding vestibular neuritis (VN) are unknown, although many cases are associated with viral infection. A 55-year-old woman was bitten by a viper on her right hand, and she was treated with antivenom at the primary clinic. Three days later, acute persistent vertigo was developed. Neuro-otologic examinations revealed spontaneous left-beating nystagmus and abnormal head impulse test in the right side. Taken together with negative result of brain magnetic resonance imaging, she was diagnosed with a right VN. Various neurological complications such as paralysis, optic neuritis, and stroke can occur after snakebite envenoming. In this case, given the time interval between snakebite and development of dizziness, snakebite envenoming might be a possible predisposing factor of VN as a proinflammatory condition rather than a direct cause of VN. Furthermore, the VN of this case was probably caused by late adverse reactions after antivenom administration. Since about 10% of the snake-bitten patients have complained dizziness, detailed neuro-otologic evaluations may lead to a proper understanding of pathomechanism and a correct diagnosis.

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